Individual
JEFFREY LEWIS POLCZINSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
5555 N PORT WASHINGTON RD, SUITE 304, GLENDALE, WI 53217
(414) 967-9550
(414) 967-9550
Mailing address
5555 N PORT WASHINGTON RD, SUITE 304, GLENDALE, WI 53217
(414) 967-9550
(414) 967-9550
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1641057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1641057
PSCYHOLOGIST LICENSE
WI
05
—
39131300
—
WI
Enumeration date
07/07/2006
Last updated
03/14/2008
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