Provider Demographics
NPI:1497989206
Name:GRAY-SCHMIEDLIN, INDIA DEGWEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:INDIA
Middle Name:DEGWEN
Last Name:GRAY-SCHMIEDLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3863 N 53RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2201
Mailing Address - Country:US
Mailing Address - Phone:414-324-1909
Mailing Address - Fax:
Practice Address - Street 1:2305 ECHO HARBOR DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1570
Practice Address - Country:US
Practice Address - Phone:414-324-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI94489225C00000X
WI301-266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor