Pediatric Psychology Associates LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

613 057 Issued in WI

Legal business name

PEDIATRIC PSYCHOLOGY ASSOCIATES LLC

Practice address

3636 N 124TH St
3Rd Floor
Wauwatosa, WI 53222-2125

Phone

(414) 476-9755

Fax

(414) 476-3413

NPI assigned

Nov 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tracy R Pritzl, PSYD, BCBA-D

Title

Director Owner

Phone

(414) 476-9755

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Autism Behavioral Network Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474934400000",
    "number": "1124193065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3636 N 124TH ST",
            "address_2": "3RD FLOOR",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532222125",
            "telephone_number": "414-476-9755",
            "fax_number": "414-476-3413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 N 124TH ST",
            "address_2": "3RD FLOOR",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532222125",
            "telephone_number": "414-476-9755",
            "fax_number": "414-476-3413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PSYCHOLOGY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2016-09-27",
        "status": "A",
        "authorized_official_last_name": "PRITZL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OWNER",
        "authorized_official_telephone_number": "414-476-9755",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, BCBA-D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "613 057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42212500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autism Behavioral Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Trisha Pavicich
• Michael Garrett Payne, D.D.S.
• Bryan James Peacock, L.P.C.
• James Frank Pechloff Jr., DDS
• Dean Pecor
• Pediatric Rehabilitation Medicine Associates,LLC
• Kelsey Paige Pendleton
• Regina Penn, MS, LPC
• Joahne C Penney, LPN
• Jolanta Pentala, MD

• Clinical Psychologist in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.