Provider Demographics
NPI:1255704201
Name:MISCHLER, BRYAN (LCSW)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:MISCHLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-8049
Mailing Address - Country:US
Mailing Address - Phone:920-926-2300
Mailing Address - Fax:920-907-8209
Practice Address - Street 1:40 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-8049
Practice Address - Country:US
Practice Address - Phone:920-926-2300
Practice Address - Fax:920-907-8209
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129967 - 121104100000X
WI8878-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker