Provider Demographics
NPI:1003944737
Name:MUERHOFF-SCHWEDA, JEAN A (PSYD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:MUERHOFF-SCHWEDA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19435 W CAPITOL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2737
Mailing Address - Country:US
Mailing Address - Phone:262-366-3662
Mailing Address - Fax:
Practice Address - Street 1:1220 DEWEY AVE
Practice Address - Street 2:LORTON BLDG, RM 208
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2504
Practice Address - Country:US
Practice Address - Phone:414-454-6731
Practice Address - Fax:414-454-6721
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2681-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43566000Medicaid