Provider Demographics
NPI:1720169675
Name:SCHREIBER, STEVEN LESLIE (CSAC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LESLIE
Last Name:SCHREIBER
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4851 HIGHWAY 63 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801
Mailing Address - Country:US
Mailing Address - Phone:715-635-4858
Mailing Address - Fax:715-635-3794
Practice Address - Street 1:N4851 HIGHWAY 63 SOUTH
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801
Practice Address - Country:US
Practice Address - Phone:715-635-4858
Practice Address - Fax:715-635-3794
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11013101YA0400X
WI4734-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1720169675Medicaid