Individual
DR. DEREK JEREMY JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
631 FOREST ST, WAUSAU, WI 54403-5524
(715) 842-0944
(715) 845-6477
Mailing address
631 FOREST ST, WAUSAU, WI 54403-5524
(715) 842-0944
(715) 845-6477
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2306-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2187795
CIGNA BEHAVIORAL HEALTH
—
01
—
332603
MANAGED HEALTH NETWORK
—
01
—
87249
SECURITY HEALTH INSURANCE
WI
Enumeration date
07/19/2006
Last updated
07/08/2007
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