Individual
DR. JILL M. WOLLENZIEN-DANIELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2290 RICKIE DR, MOSINEE, WI 54455-8848
(715) 298-2104
Mailing address
2290 RICKIE DR, MOSINEE, WI 54455-8848
(715) 298-2104
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
2273-057
WI
103TA0400X
Addiction (Substance Use Disorder) Psychologist
2273-057
WI
103TA0700X
Adult Development & Aging Psychologist
2273-057
WI
103TB0200X
Cognitive & Behavioral Psychologist
2273-057
WI
103TC0700X
Clinical Psychologist
Primary
2273-057
WI
103TC2200X
Clinical Child & Adolescent Psychologist
2273-057
WI
103TF0200X
Forensic Psychologist
2273-057
WI
103TM1800X
Intellectual & Developmental Disabilities Psychologist
2273-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39274400
—
WI
Enumeration date
02/01/2007
Last updated
02/11/2009
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