Provider Demographics
NPI:1700272929
Name:SCHMIDT, KERRI (LPC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 WILLARD DRIVE
Mailing Address - Street 2:SUITE #136
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-6223
Mailing Address - Country:US
Mailing Address - Phone:920-328-0717
Mailing Address - Fax:920-328-0715
Practice Address - Street 1:916 WILLARD DRIVE
Practice Address - Street 2:SUITE #136
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-6223
Practice Address - Country:US
Practice Address - Phone:920-328-0717
Practice Address - Fax:920-328-0715
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5618-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100073858Medicaid
WI13528225OtherCAQH