Provider Demographics
NPI:1568723161
Name:SCHLEPPENBACH, WAYNE (LADC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:SCHLEPPENBACH
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3770
Mailing Address - Country:US
Mailing Address - Phone:218-839-7796
Mailing Address - Fax:
Practice Address - Street 1:823 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3770
Practice Address - Country:US
Practice Address - Phone:218-839-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300721101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)