Provider Demographics
NPI:1457700478
Name:SCHMALZ, SARA NICHOLE (LPC-IT, SAC-IT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:NICHOLE
Last Name:SCHMALZ
Suffix:
Gender:F
Credentials:LPC-IT, SAC-IT
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:NICHOLE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-IT, SAC-IT
Mailing Address - Street 1:12506 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-2663
Mailing Address - Country:US
Mailing Address - Phone:414-745-3894
Mailing Address - Fax:
Practice Address - Street 1:19115 W CAPITOL DR
Practice Address - Street 2:SUITE 117
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2754
Practice Address - Country:US
Practice Address - Phone:262-781-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2508-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional