MEDICARE: MR. GERALD ROBERT SCHWAN M.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	292-123	WI

General Provider Information

NPI Number	:	1659649390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD ROBERT SCHWAN M.S.W.

Provider Business Mailing Address
First Line	:	2949 LUMBER LN
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54313-5823
Country	:	US
Telephone Number	:	920-265-0412
Fax Number	:

Provider Business Practice Location Address
First Line	:	1922 UNIVERSITY AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-1880
Country	:	US
Telephone Number	:	920-432-0600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	12/08/2011

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