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General NPI Number Information
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NPI Number | 1396568895
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Entity Type | Individual
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Provider Name | JENNIFER MOORE VICE-RESHEL PHD
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 1250 N 113TH STREET SUITE 200
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City | WAWATOSA
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State | WI
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Zip | 53226-3209
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Country | US
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Telephone | 262-432-6600
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Fax | 424-432-6604
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Provider Business Mailing Address
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Address Line | 7330 N MOHAWK RD
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City | FOX POINT
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State | WI
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Zip | 53217-3454
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Country | US
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Telephone | 330-256-4143
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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 | 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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