Provider Demographics
NPI:1588189740
Name:SCHALLER, JOHN III (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SCHALLER
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6144 AEROTECH DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-7503
Mailing Address - Country:US
Mailing Address - Phone:920-733-2065
Mailing Address - Fax:920-733-6565
Practice Address - Street 1:W6144 AEROTECH DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-7503
Practice Address - Country:US
Practice Address - Phone:920-733-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3622-226101YM0800X
WI7479-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health