Individual
JAMES JEFFREY CRISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3636 N 124TH ST, SUITE 200, WAUWATOSA, WI 53222-2125
(414) 476-9755
(414) 476-3413
Mailing address
3636 N 124TH ST, SUITE 200, WAUWATOSA, WI 53222-2125
(414) 476-9755
(414) 476-3413
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
613-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39010900
—
WI
Enumeration date
07/23/2008
Last updated
04/22/2009
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