Healthcare Provider Details

I. General information

NPI: 1083778781
Provider Name (Legal Business Name): DOUGLAS RALPH HIGBIE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 W MITCHELL ST
MILWAUKEE WI
53204
US

IV. Provider business mailing address

3149 W COLONY DR
GREENFIELD WI
53221-2161
US

V. Phone/Fax

Practice location:
  • Phone: 414-383-4486
  • Fax:
Mailing address:
  • Phone: 414-325-3698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1934-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: