Healthcare Provider Details

I. General information

NPI: 1215844105
Provider Name (Legal Business Name): JOCELYN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 S 78TH ST
MILWAUKEE WI
53220-1603
US

IV. Provider business mailing address

11750 W WHITAKER AVE
GREENFIELD WI
53228-2454
US

V. Phone/Fax

Practice location:
  • Phone: 414-604-7330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: