Organization
NORTH SHORE PSYCHOTHERAPY ASSOCIATES IV
Active
Other names
NSPA
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHERYL DOLEZAL PSYD (CO DIRECTOR)
(414) 962-6764
Entity
Organization
Contact information
Practice address
5555 N PORT WASHINGTON RD STE 300, GLENDALE, WI 53217-4928
(414) 962-6764
(414) 962-6765
Mailing address
5555 N PORT WASHINGTON RD STE 300, GLENDALE, WI 53217-4928
(414) 962-6764
(414) 962-6765
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100047128
—
WI
01
—
K100345509
MEDICARE
WI
Enumeration date
10/24/2006
Last updated
05/08/2023
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