Healthcare Provider Details

I. General information

NPI: 1841816659
Provider Name (Legal Business Name): DEVIN MATTHEW FRANKLIN PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W FLORIST AVE
GLENDALE WI
53209-3800
US

IV. Provider business mailing address

1720 W FLORIST AVE
GLENDALE WI
53209-3800
US

V. Phone/Fax

Practice location:
  • Phone: 414-247-0801
  • Fax: 141-247-0816
Mailing address:
  • Phone: 414-247-0801
  • Fax: 141-247-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4630
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: