Individual
DR. PETER JOHN GRASKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
5000 W NATIONAL AVE RM 4160, MILWAUKEE, WI 53295-0001
(414) 384-2000
Mailing address
5000 W NATIONAL AVE RM 4160, MILWAUKEE, WI 53295-0001
(414) 384-2000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2875-57
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2875-57
PSYCHOLOGIST LICENSE NUMBER
WI
01
—
391746222
CORNERSTONE TAX ID
WI
05
—
40965200
—
WI
Enumeration date
08/01/2006
Last updated
01/16/2020
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