Provider Demographics
NPI:1548560162
Name:SCHLADER, ANTHONY DAVID (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DAVID
Last Name:SCHLADER
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 TREELAND DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-1922
Mailing Address - Country:US
Mailing Address - Phone:920-288-9104
Mailing Address - Fax:
Practice Address - Street 1:1808 TREELAND DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1922
Practice Address - Country:US
Practice Address - Phone:920-288-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3380-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40941500Medicaid