Healthcare Provider Details

I. General information

NPI: 1710274691
Provider Name (Legal Business Name): WAYNE CHEN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10045 W LISBON AVE
WAUWATOSA WI
53222
US

IV. Provider business mailing address

N99W14600 AMBER DR
GERMANTOWN WI
53022-6611
US

V. Phone/Fax

Practice location:
  • Phone: 414-358-7144
  • Fax: 414-358-7158
Mailing address:
  • Phone: 262-365-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3429-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: