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General NPI Number Information
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NPI Number | 1467703223
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Entity Type | Individual
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Provider Name | JONATHAN T GRAPENGIESER PSYD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 1126 S 70TH ST SUITE S507
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City | WEST ALLIS
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State | WI
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Zip | 53214-3151
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Country | US
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Telephone | 414-475-2788
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Fax | 414-476-8695
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Provider Business Mailing Address
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Address Line | 1126 S 70TH ST SUITE S507
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City | WEST ALLIS
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State | WI
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Zip | 53214-3151
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Country | US
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Telephone | 414-475-2788
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Fax | 414-476-8695
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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 | 3170-57
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License Number State | WI
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