Individual
MARY C BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
10201 W LINCOLN AVE, 308, WEST ALLIS, WI 53227-2136
(414) 329-7000
(414) 329-7010
Mailing address
10201 W LINCOLN AVE, 308, WEST ALLIS, WI 53227-2136
(414) 329-7000
(414) 329-7010
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2219057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39144700
—
WI
Enumeration date
08/31/2006
Last updated
02/11/2009
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