Healthcare Provider Details

I. General information

NPI: 1124951868
Provider Name (Legal Business Name): JASON CRAIG SCHRADER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12630 W NORTH AVE BLDG E
BROOKFIELD WI
53005-4626
US

IV. Provider business mailing address

208 S JAMES ST
WAUKESHA WI
53186-6223
US

V. Phone/Fax

Practice location:
  • Phone: 262-785-1008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8988-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: