| NPI | 1689770497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN S. FULLER Office Manager 414-962-4048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 104100000X Social Worker |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2020-08-22 |