Provider Demographics
NPI:1104078096
Name:SCHUPNER, RICHARD WILLIAM (MA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:SCHUPNER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 BULL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7410
Mailing Address - Country:US
Mailing Address - Phone:815-578-0115
Mailing Address - Fax:
Practice Address - Street 1:5419 BULL VALLEY RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7410
Practice Address - Country:US
Practice Address - Phone:815-578-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional