Individual
MS. MARY JO KUPST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
9000 WEST WISCONSIN AVE, CHILDREN'S HOSPITAL OF WISCONSIN, MILWAUKEE, WI 53226
(414) 805-3666
Mailing address
9000 W WISCONSIN AVE, CHILDREN'S HOSPITAL OF WISCONSIN, MILWAUKEE, WI 53226-3518
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1479
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39082000
—
WI
Enumeration date
05/15/2006
Last updated
07/08/2007
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