Individual
JOHN M O'DONNELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
5225 N IRONWOOD LN, SUITE # 212, GLENDALE, WI 53217-4909
(414) 962-1000
Mailing address
2121 LOFTY LN, SAUKVILLE, WI 53080-2300
(262) 375-8653
(262) 375-0722
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
561-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39055600
—
WI
Enumeration date
03/24/2006
Last updated
07/09/2007
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