Healthcare Provider Details

I. General information

NPI: 1699107102
Provider Name (Legal Business Name): BRIDGET D WOZNIAK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 N PROSPECT AVE
MILWAUKEE WI
53211-4445
US

IV. Provider business mailing address

2222 S 114TH ST
WEST ALLIS WI
53227-1031
US

V. Phone/Fax

Practice location:
  • Phone: 414-319-3000
  • Fax:
Mailing address:
  • Phone: 414-449-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number3676
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3676
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: