Individual
JONATHAN JAMES MIETCHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
T-LMLP
Contact information
Practice address
600 HIGHLAND AVE, MADISON, WI 53792-9469
(608) 263-5430
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
3815-57
WI
103TC0700X
Clinical Psychologist
2795
KS
Other
Enumeration date
08/23/2017
Last updated
02/08/2021
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