Individual
DR. JILL C. RUDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2665 S MOORLAND RD, SUITE 100, NEW BERLIN, WI 53151
(414) 475-1896
(414) 988-9764
Mailing address
2665 S MOORLAND RD, SUITE 100, NEW BERLIN, WI 53151-2900
(414) 475-1896
(414) 988-9764
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1095559
WI
103TC0700X
Clinical Psychologist
Primary
2172-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39679600
—
WI
Enumeration date
02/20/2007
Last updated
09/05/2018
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