Provider Demographics
NPI:1760132880
Name:SCHWARZ, GREGOR NATHANAEL PAU (PHD)
Entity Type:Individual
Prefix:
First Name:GREGOR
Middle Name:NATHANAEL PAU
Last Name:SCHWARZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 N PORT WASHINGTON RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5760
Mailing Address - Country:US
Mailing Address - Phone:262-241-5955
Mailing Address - Fax:
Practice Address - Street 1:10335 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5763
Practice Address - Country:US
Practice Address - Phone:262-241-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4042-57103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty