Provider Demographics
NPI:1992554695
Name:SCHUBART, RAQUEL RENEE
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:RENEE
Last Name:SCHUBART
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 1:3271 FONDOTTO DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-9539
Mailing Address - Country:US
Mailing Address - Phone:920-659-1089
Mailing Address - Fax:
Practice Address - Street 1:976 AMERICAN DR STE 14
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-1933
Practice Address - Country:US
Practice Address - Phone:920-215-3401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7177-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional