Basic Information
| Provider Information | |||||||||
| NPI: | 1104226729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHOEPPACH | ||||||||
| FirstName: | MARISA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 W CLEARBROOK DR # 25 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982292353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602247190 | ||||||||
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| Practice Location | |||||||||
| Address1: | 609 N SHORE DR | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982264414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606766000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2014 | ||||||||
| LastUpdateDate: | 09/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.