Organization
DYNAMIC POTENTIAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE R RASZKIEWICZ PHD (LICENSED PSYCHOLOGIST)
(262) 308-8085
Entity
Organization
Contact information
Practice address
316 5TH ST STE 2, RACINE, WI 53403-4606
(262) 308-8085
Mailing address
PO BOX 1943, KENOSHA, WI 53141-1943
(262) 308-8085
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TC1900X
Counseling Psychologist
Primary
—
—
103TF0000X
Family Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40968000
—
WI
Enumeration date
12/19/2019
Last updated
02/24/2020
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