Healthcare Provider Details

I. General information

NPI: 1033073739
Provider Name (Legal Business Name): CHRISTIAN ALAN AVERY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 N IDLEWILD AVE
MILWAUKEE WI
53217-5969
US

IV. Provider business mailing address

4913 N IDLEWILD AVE
MILWAUKEE WI
53217-5969
US

V. Phone/Fax

Practice location:
  • Phone: 239-401-0127
  • Fax:
Mailing address:
  • Phone: 239-401-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number16750930
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number546457
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: