| NPI | 1578023156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLIE D. LOCKE Chief Executive Officer 262-455-2919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2019-03-21 |