Basic Information
| Provider Information | |||||||||
| NPI: | 1255704201 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MISCHLER | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 CAMELOT DR | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549358049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209262300 | ||||||||
| FaxNumber: | 9209078209 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 CAMELOT DR | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549358049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209262300 | ||||||||
| FaxNumber: | 9209078209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2015 | ||||||||
| LastUpdateDate: | 03/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 129967 - 121 | WI | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 8878-123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.