Provider Demographics
NPI:1962238758
Name:MISCHO, EDWARD (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:MISCHO
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S75W31046 FLORENCE CT
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9215
Mailing Address - Country:US
Mailing Address - Phone:262-949-9028
Mailing Address - Fax:
Practice Address - Street 1:S75W31046 FLORENCE CT
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9215
Practice Address - Country:US
Practice Address - Phone:262-949-9028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11692-123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker