Provider Demographics
NPI:1619257722
Name:SCHUPICK, ELEANOR ANGELINE (MA, CADC)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:ANGELINE
Last Name:SCHUPICK
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SOUTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9407
Mailing Address - Country:US
Mailing Address - Phone:319-752-4000
Mailing Address - Fax:
Practice Address - Street 1:400 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9407
Practice Address - Country:US
Practice Address - Phone:319-752-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA94134101YA0400X
IA080309.101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA94134OtherCERTIFIED ALCOHOL AND DRUG COUNSELOR