Healthcare Provider Details

I. General information

NPI: 1841242294
Provider Name (Legal Business Name): JO M WEIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 NORTH MAYFAIR ROAD BEHAVIORAL HEALTH CLINIC @ TOSA
MILWAUKEE WI
53226
US

IV. Provider business mailing address

1155 N MAYFAIR RD BEHAVIORAL HEALTH CLINIC @ TOSA
MILWAUKEE WI
53226-3421
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-8900
  • Fax: 414-955-6285
Mailing address:
  • Phone: 414-955-8900
  • Fax: 414-955-6285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number2245
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: