Provider Demographics
NPI:1386837573
Name:MUELLER, JOHN A (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MUELLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 S ANDREWS ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-2406
Mailing Address - Country:US
Mailing Address - Phone:715-524-4840
Mailing Address - Fax:
Practice Address - Street 1:324 S ANDREWS ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2406
Practice Address - Country:US
Practice Address - Phone:715-524-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical