Healthcare Provider Details

I. General information

NPI: 1063433951
Provider Name (Legal Business Name): JULIETTE MARTIN-THOMAS PHD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W BROWN DEER RD STE 216
FOX POINT WI
53217-6204
US

IV. Provider business mailing address

1001 W GLEN OAKS LN STE 105
MEQUON WI
53092-3369
US

V. Phone/Fax

Practice location:
  • Phone: 414-365-9444
  • Fax:
Mailing address:
  • Phone: 414-434-8514
  • Fax: 414-365-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIETTE MARTIN-THOMAS
Title or Position: OWNER/PRESIDENT
Credential: PHD
Phone: 414-365-9444