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General NPI Number Information
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NPI Number | 1154766004
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Entity Type | Individual
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Provider Name | SUZANNE J. LISOWSKI PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 2230 S KINNICKINNIC AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-1330
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Country | US
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Telephone | 414-769-1989
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Fax | 414-769-1989
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Provider Business Mailing Address
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Address Line | 2230 S KINNICKINNIC AVE 2230 S KINNICKINNIC AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-1330
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Country | US
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Telephone | 414-769-1989
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Fax | 414-769-1989
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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 | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 899-57
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License Number State |
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