Individual provider Active NPI

Jacob J Milosavljevic

  • Clinical Child & Adolescent Psychologist
  • Brookfield, WI
National Provider Identifier
1356189054
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Practice address
200 N Patrick Blvd
Brookfield, WI 53045-5883
Phone
(888) 754-0398
NPI assigned
Jul 17, 2024
Last updated
Jul 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X Primary

Addresses

Primary practice location

200 N Patrick Blvd
Brookfield, WI 53045-5883

Mailing address

2646 E Henry Ave
Cudahy, WI 53110-2822
Phone (414) 482-4092

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1721174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1356189054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2646 E HENRY AVE",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531102822",
            "telephone_number": "414-482-4092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N PATRICK BLVD",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455883",
            "telephone_number": "888-754-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILOSAVLJEVIC",
        "first_name": "JACOB",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-17",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.