=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972919314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHOLOGICAL & HR CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2014
-----------------------------------------------------
Last Update Date | 07/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4317 N STOWELL AVE
-----------------------------------------------------
City | SHOREWOOD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53211-1748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-403-1481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4317 N STOWELL AVE
-----------------------------------------------------
City | SHOREWOOD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53211-1748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-403-1481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | ROBERT J LUEGER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 414-403-1481
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number | 984-57
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 984-57
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------