Individual
DR. CHARLES MATHEW LODL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
11501 N PORT WASHINGTON RD, SUITE 210, MEQUON, WI 53092-3466
(262) 241-8901
(262) 241-8907
Mailing address
11501 N PORT WASHINGTON RD, SUITE 210, MEQUON, WI 53092-3466
(262) 241-8901
(262) 241-8907
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
857-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39050600
—
WI
Enumeration date
07/25/2006
Last updated
07/08/2007
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