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General NPI Number Information
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NPI Number | 1659598746
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Entity Type | Individual
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Provider Name | CHRISTOPHER PAUL WIEBUSCH PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | N27W23953 PAUL RD STE. 206
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City | PEWAUKEE
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State | WI
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Zip | 53072-6242
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Country | US
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Telephone | 262-347-0701
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Fax | 262-347-0705
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Provider Business Mailing Address
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Address Line | N27W23953 PAUL RD STE. 206
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City | PEWAUKEE
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State | WI
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Zip | 53072-6242
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Country | US
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Telephone | 262-347-0701
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Fax | 262-347-0705
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 1920 057
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 1920 057
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1920
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License Number State | WI
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