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General NPI Number Information
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NPI Number | 1841490364
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Entity Type | Organization
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Legal Business Name | ACADEMIC & FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 9120 W HAMPTON AVE SUITE 119
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City | MILWAUKEE
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State | WI
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Zip | 53225-4960
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Country | US
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Telephone | 262-783-7778
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Fax | 414-464-9510
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Provider Business Mailing Address
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Address Line | 9120 W HAMPTON AVE SUITE 119
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City | MILWAUKEE
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State | WI
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Zip | 53225-4960
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Country | US
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Telephone | 262-783-7778
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Fax | 414-464-9510
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELLEN G. STERN
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Credential | PH.D.
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Telephone | 262-783-7778
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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 | 745-057
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License Number State | WI
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