Healthcare Provider Details

I. General information

NPI: 1568569705
Provider Name (Legal Business Name): DAMIAN A VRANIAK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W3177 HAMILTON RD
SPRINGBROOK WI
54875-9314
US

IV. Provider business mailing address

W3177 HAMILTON RD
SPRINGBROOK WI
54875-9314
US

V. Phone/Fax

Practice location:
  • Phone: 715-766-2045
  • Fax:
Mailing address:
  • Phone: 715-766-2045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number885
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: