1255398541 NPI number — DR. RAE J SCHILLING PH.D, PSY.D.

Table of content: DR. RAE J SCHILLING PH.D, PSY.D. (NPI 1255398541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255398541 NPI number — DR. RAE J SCHILLING PH.D, PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHILLING
Provider First Name:
RAE
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D, PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255398541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 NEWTON ST
Provider Second Line Business Mailing Address:
STE. 204
Provider Business Mailing Address City Name:
EAU CLAIRE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54701-3812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-225-1259
Provider Business Mailing Address Fax Number:
715-514-4008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
914 PORTER AVE SUITE 2
Provider Second Line Business Practice Location Address:
PORTER PLACE
Provider Business Practice Location Address City Name:
EAU CLAIRE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54701-0814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-225-1259
Provider Business Practice Location Address Fax Number:
715-514-4008
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TF0000X , with the licence number:  1783057 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 64124 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6176078 . This is a "UBH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 637871026342 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP42692 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 27624 . This is a "SECURITY HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 39230200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6176078 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6176078 . This is a "UHC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8HO11SC . This is a "BCBS MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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