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General NPI Number Information
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NPI Number | 1518959436
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Entity Type | Individual
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Provider Name | BRADLEY CHRISTOPHER RIEMANN PHD
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 34700 VALLEY RD
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4500
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Country | US
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Telephone | 800-767-4411
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Fax | 262-646-7067
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Provider Business Mailing Address
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Address Line | 3630 N HICKORY LN
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4532
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Country | US
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Telephone | 800-767-4411
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Fax | 262-646-7067
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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 | 1853
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License Number State | WI
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