Organization
PSYCH MED MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. THERESE JAECKLE APNP (OWNER)
(414) 530-1878
Entity
Organization
Contact information
Practice address
140 S MAIN ST, THIENSVILLE, WI 53092-1956
(262) 402-7964
(262) 261-5062
Mailing address
140 S MAIN ST, THIENSVILLE, WI 53092-1956
(262) 402-7964
(262) 261-5062
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
3319-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063696516
—
WI
Enumeration date
12/12/2014
Last updated
12/12/2014
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