| NPI | 1639415078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LYNNE MACK Psychologist 262-391-2551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 2598-057) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2026-01-09 |