Individual
EARL E. BRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
5225 N IRONWOOD RD, SUITE 214, GLENDALE, WI 53217-4909
(414) 963-1115
Mailing address
5225 N IRONWOOD RD, SUITE 214, GLENDALE, WI 53217-4909
(414) 963-1115
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2295-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43567200
—
WI
Enumeration date
11/14/2007
Last updated
11/14/2007
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