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General NPI Number Information
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NPI Number | 1063433951
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Entity Type | Organization
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Legal Business Name | JULIETTE MARTIN-THOMAS PHD SC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 8901 N 76TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53223-1901
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Country | US
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Telephone | 414-365-9444
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 W GLEN OAKS LN STE 105
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City | MEQUON
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State | WI
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Zip | 53092-3369
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Country | US
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Telephone | 414-365-3210
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JULIETTE MARTIN-THOMAS
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Credential | PHD
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Telephone | 414-365-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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