Healthcare Provider Details

I. General information

NPI: 1922318393
Provider Name (Legal Business Name): ARIANE MACHIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 W. WISCONSIN AVE #2B
PEWAUKEE WI
53072
US

IV. Provider business mailing address

161 W. WISCONSIN AVE #2B
PEWAUKEE WI
53072
US

V. Phone/Fax

Practice location:
  • Phone: 262-695-8857
  • Fax: 262-695-8879
Mailing address:
  • Phone: 262-695-8857
  • Fax: 262-695-8879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2893-57
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number2893-57
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number2893-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: