Healthcare Provider Details

I. General information

NPI: 1093622151
Provider Name (Legal Business Name): JONATHON ROBERT LOMBARDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2463 N BUFFUM ST
MILWAUKEE WI
53212-2901
US

IV. Provider business mailing address

5947 S HONEY CREEK DR
GREENFIELD WI
53221-4825
US

V. Phone/Fax

Practice location:
  • Phone: 414-267-1313
  • Fax:
Mailing address:
  • Phone: 414-267-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3001029877
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: