Organization
PSYCH AFFILIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS LEE KOCHANIK (PRESIDENT)
(414) 502-7216
Entity
Organization
Contact information
Practice address
11431 N PORT WASHINGTON RD STE 101B, MEQUON, WI 53092-3463
(414) 502-7216
Mailing address
11431 N PORT WASHINGTON RD STE 101B, MEQUON, WI 53092-3463
(267) 699-8834
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100190462
—
WI
Enumeration date
03/12/2022
Last updated
02/05/2024
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