Individual
LACEY M BUKHARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6600
Mailing address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6600
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3424-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100061972
—
WI
Enumeration date
10/07/2016
Last updated
11/29/2021
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