Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2383057 | WI |
N | 103T00000X | Psychologist | 2383057 | WI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2383057 | WI |
NPI | 1417057555 |
---|---|
Provider Name | Dr. James Kevin Giese |
First Address | West Bend, WI 53090 |
Second Address | West Bend, WI 53090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |