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General NPI Number Information
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NPI Number | 1023024791
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Entity Type | Individual
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Provider Name | PETER JOHN GRASKAMP PHD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 5000 W NATIONAL AVE RM 4160
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City | MILWAUKEE
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State | WI
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Zip | 53295-0001
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Country | US
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Telephone | 414-384-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 W NATIONAL AVE RM 4160
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City | MILWAUKEE
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State | WI
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Zip | 53295-0001
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Country | US
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Telephone | 414-384-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2875-57
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License Number State | WI
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