Individual
DAVID J. WAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
557 N WASHINGTON ST, JANESVILLE, WI 53548
(608) 754-6000
(608) 755-7892
Mailing address
557 N WASHINGTON ST, JANESVILLE, WI 53548-2907
(608) 754-6000
(608) 755-7892
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
071-002790
IL
103TC0700X
Clinical Psychologist
Primary
2711-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134228802
—
WI
01
—
541760589
WI MEDICARE
WI
01
—
P00684638CD3624
RR MEDICARE
WI
01
—
WAKELDAV
MERCYCARE INSURANCE
WI
Enumeration date
09/21/2006
Last updated
06/14/2018
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