Provider Demographics
NPI:1578814026
Name:LINDA SCHWALLIE LLC
Entity Type:Organization
Organization Name:LINDA SCHWALLIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWALLIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:920-621-3036
Mailing Address - Street 1:122 MIRAMAR DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1924
Mailing Address - Country:US
Mailing Address - Phone:920-621-3036
Mailing Address - Fax:
Practice Address - Street 1:926 WILLARD DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5071
Practice Address - Country:US
Practice Address - Phone:920-621-3036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty