Healthcare Provider Details

I. General information

NPI: 1578620761
Provider Name (Legal Business Name): JOHN R BRIGGS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 MIDWAY RD
MENASHA WI
54952-1115
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-720-2300
  • Fax:
Mailing address:
  • Phone: 920-720-2300
  • Fax: 920-720-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1983-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: