Individual
NANCY A CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
11520 N PORT WASHINGTON ROAD, SUITE 108, MEQUON, WI 53092-3352
(414) 803-9967
Mailing address
11520 N PORT WASHINGTON ROAD, SUITE 108, MEQUON, WI 53092-3352
(414) 803-9967
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2523057
WI
Other
Enumeration date
07/26/2006
Last updated
07/08/2007
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