| NPI | 1245245794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONITA JEAN DEBBAN Owner 262-567-7900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 2324-057) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2020-08-22 |