Healthcare Provider Details

I. General information

NPI: 1720105877
Provider Name (Legal Business Name): GLASSMAN & STANIK CONSULTING PSYCHOLOGISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7635 W OKLAHOMA AVE SUITE 201
MILWAUKEE WI
53219-3600
US

IV. Provider business mailing address

7635 W OKLAHOMA AVE SUITE 201
MILWAUKEE WI
53219-3600
US

V. Phone/Fax

Practice location:
  • Phone: 414-444-9811
  • Fax: 414-444-9822
Mailing address:
  • Phone: 414-444-9811
  • Fax: 414-444-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1998
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1653
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1998
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1653
License Number StateWI

VIII. Authorized Official

Name: NATHAN D. GLASSMAN
Title or Position: DOCTOR
Credential: PHD
Phone: 414-444-9811