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General NPI Number Information
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NPI Number | 1942335260
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Entity Type | Individual
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Provider Name | MYLES D TONNACLIFF PHD
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | W62N248 WASHINGTON AVE STE 208
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City | CEDARBURG
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State | WI
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Zip | 53012-2768
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Country | US
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Telephone | 262-618-2856
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Fax |
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Provider Business Mailing Address
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Address Line | W62N248 WASHINGTON AVE STE 208
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City | CEDARBURG
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State | WI
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Zip | 53012-2768
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Country | US
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Telephone | 622-618-2856
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2282-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2163-057
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License Number State | WI
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