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Organization
NORTH SHORE PSYCHOTHERAPY ASSOCIATES IV
Active
Organization
NORTH SHORE PSYCHOTHERAPY ASSOCIATES IV
Active
Other names
NSPA
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHERYL DOLEZAL PSYD (CO DIRECTOR)
(414) 962-6764
Entity
Organization
Contact information
Practice address
5555 N PORT WASHINGTON RD STE 300, GLENDALE, WI 53217-4928
(414) 962-6764
(414) 962-6765
Mailing address
5555 N PORT WASHINGTON RD STE 300, GLENDALE, WI 53217-4928
(414) 962-6764
(414) 962-6765
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100047128
—
WI
01
—
K100345509
MEDICARE
WI
Enumeration date
10/24/2006
Last updated
05/08/2023
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