Healthcare Provider Details

I. General information

NPI: 1518907633
Provider Name (Legal Business Name): JULIETTE MARTIN THOMAS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
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 Number906057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: