Basic Information
Provider Information
NPI: 1518263276
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHEPKE
FirstName: PHYLLIS
MiddleName: LYNNE
NamePrefix: MRS.
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1035 W WASHINGTON AVE
Address2:  
City: ALPENA
State: MI
PostalCode: 497072929
CountryCode: US
TelephoneNumber: 9893580673
FaxNumber:  
Practice Location
Address1: 346 LONG RAPIDS PLZ
Address2:  
City: ALPENA
State: MI
PostalCode: 497071374
CountryCode: US
TelephoneNumber: 9893583500
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/28/2011
LastUpdateDate: 11/23/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/23/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X6801089631MIY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


Home