Organization
WISCONSIN SCHOOL OF PROFESSIONAL PSYCHOLOGY
Active
Other names
WSPP Psychology Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN ANN DVORAK PH.D. (DIRECTOR OF CLINICAL TRAINING)
(414) 466-9777
Entity
Organization
Contact information
Practice address
9120 W HAMPTON AVE, SUITE 90, MILWAUKEE, WI 53225-4960
(414) 466-9777
(414) 358-5590
Mailing address
9120 W HAMPTON AVE, SUITE 90, MILWAUKEE, WI 53225-4960
(414) 466-9777
(414) 358-5590
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
2001
WI
103T00000X
Psychologist
Primary
2001
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42182700
—
WI
Enumeration date
05/11/2007
Last updated
06/17/2008
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