=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467363697
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISON MARISSA SCHUELLER LPC-IT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2026
-----------------------------------------------------
Last Update Date | 09/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 N FRANKLIN ST
-----------------------------------------------------
City | PORT WASHINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53074-1901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-455-0644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 907 N BENJAMIN ST
-----------------------------------------------------
City | PORT WASHINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53074-1402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-339-9769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 9297226
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------