Provider Demographics
NPI:1659649390
Name:SCHWAN, GERALD ROBERT (MSW)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ROBERT
Last Name:SCHWAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 LUMBER LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-5823
Mailing Address - Country:US
Mailing Address - Phone:920-265-0412
Mailing Address - Fax:
Practice Address - Street 1:1922 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-1880
Practice Address - Country:US
Practice Address - Phone:920-432-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI292-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical