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General NPI Number Information
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NPI Number | 1275662181
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Entity Type | Organization
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Legal Business Name | PERFORMANCE ENHANCEMENT HEALTH SERVICES, S.C.
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7400 W RAWSON AVE SUITE 213
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City | FRANKLIN
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State | WI
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Zip | 53132-8278
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Country | US
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Telephone | 414-427-7347
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Fax | 414-427-7188
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Provider Business Mailing Address
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Address Line | 7400 W RAWSON AVE SUITE 213
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City | FRANKLIN
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State | WI
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Zip | 53132-8278
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Country | US
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Telephone | 414-427-7347
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Fax | 414-427-7188
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | MS. JODI L PETERNEL
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Credential |
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Telephone | 414-427-7347
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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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