Adult & Adolescent TRT. Ctr.
Organization Active NPI Psychiatry Physician · Glendale, WI
NPI 1124286430 · NPPES record last updated May 23, 2008
Key facts
- NPI
- 1124286430
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 15620 (WI)
- Legal business name
- ADULT & ADOLESCENT TRT. CTR.
- Practice address
- 5225 N Ironwood Rd
S102
Glendale, WI 53217-4909 - Phone
- (414) 332-0552
- Fax
- (414) 962-4356
- NPI assigned
- May 23, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Jeffrey W Wilson, M.D.
- Title
- President
- Phone
- (414) 332-0552
Practitioners 1
National Provider Directory
Locations
5225 N Ironwood Rd
#S102
Glendale, WI 53217
Phone (262) 253-1863
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | 15620 | WI | Yes |
Addresses
Primary practice location
5225 N Ironwood Rd
S102
Glendale, WI 53217-4909
Mailing address
5225 N Ironwood Rd
S102
Glendale, WI 53217-4909
Phone (414) 332-0552
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.