| NPI | 1144551664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN A RYAN Director 262-370-7744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WI 2387-57) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 2387-57) |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2010-01-22 |