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Organization

ADULT & ADOLESCENT TRT. CTR.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JEFFREY W WILSON M.D. (PRESIDENT)
(414) 332-0552
Entity
Organization

Contact information

Practice address
5225 N IRONWOOD RD, S102, GLENDALE, WI 53217-4909
(414) 332-0552
(414) 962-4356
Mailing address
5225 N IRONWOOD RD, S102, GLENDALE, WI 53217-4909
(414) 332-0552

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
15620
WI

Other

Enumeration date
05/23/2008
Last updated
05/23/2008
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