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General NPI Number Information
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NPI Number | 1568890150
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Entity Type | Individual
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Provider Name | DAVID PHELPS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 401 E KILBOURN AVE SUITE 402
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City | MILWAUKEE
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State | WI
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Zip | 53202-3212
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Country | US
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Telephone | 414-269-8690
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Fax | 414-269-8657
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Provider Business Mailing Address
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Address Line | 3029 S WENTWORTH AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-3016
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Country | US
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Telephone | 414-807-6216
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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 | 3179-57
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License Number State | WI
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