Healthcare Provider Details

I. General information

NPI: 1609857770
Provider Name (Legal Business Name): JOAN KOJIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N JACKSON ST
MILWAUKEE WI
53202-2602
US

IV. Provider business mailing address

1300 N JACKSON ST
MILWAUKEE WI
53202-2602
US

V. Phone/Fax

Practice location:
  • Phone: 414-225-1300
  • Fax: 414-225-1346
Mailing address:
  • Phone: 414-225-1300
  • Fax: 414-225-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1581
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: