Provider Demographics
NPI:1740452879
Name:SCHNEIDER, PHYLLIS RUTH (RN,BSW)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:RUTH
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:RN,BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 SAINT ANDREW ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-2378
Mailing Address - Country:US
Mailing Address - Phone:608-785-5856
Mailing Address - Fax:
Practice Address - Street 1:1407 SAINT ANDREW ST STE 100
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2378
Practice Address - Country:US
Practice Address - Phone:608-785-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3746-120104100000X
WI83189-30163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker