Individual
DR. DENIS IAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
11931 W BLUEMOUND RD, WAUWATOSA, WI 53226-3905
(414) 276-8669
(414) 276-1266
Mailing address
11931 W BLUEMOUND RD, WAUWATOSA, WI 53226-3905
(414) 276-8669
(414) 276-1266
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1965
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39185400
—
WI
Enumeration date
10/02/2006
Last updated
11/12/2008
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