Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 0439 | WI |
N | 103T00000X | Psychologist | 0439 | WI |
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103G00000X | Clinical Psychologist | 0439 | WI |
N | 103TC0700X | Clinical Psychologist | 0439 | WI |
N | 103TF0200X | Forensic Psychologist | ||
N | 103TH0100X | Health Service |
NPI | 1811198807 |
---|---|
Provider Name | Dr. Andrew W Kane |
First Address | Milwaukee, WI 53211-3439 |
Second Address | Milwaukee, WI 53211-3439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39052400 | (05) | WI |