Provider Demographics
NPI:1538237185
Name:SCHUBRING, JENNIFER JJ
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JJ
Last Name:SCHUBRING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3989 THREE PENNY CT
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7964
Mailing Address - Country:US
Mailing Address - Phone:920-246-6297
Mailing Address - Fax:
Practice Address - Street 1:3989 THREE PENNY CT
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-7964
Practice Address - Country:US
Practice Address - Phone:920-246-6297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2896-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI717428OtherT19 MANAGED HEALTH
WI42739800Medicaid