Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1758 | WI |
N | 103T00000X | Psychologist | 1758 | WI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1758 | WI |
N | 103TA0700X | Adult Development & Aging Psychologist | 1758 | WI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1758 | WI |
N | 103G00000X | Clinical Psychologist | 1758 | WI |
N | 103TC0700X | Clinical Psychologist | 1758 | WI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1758 | WI |
N | 103TF0000X | Family Psychologist | 1758 | WI |
N | 103TF0200X | Forensic Psychologist | 1758 | WI |
N | 103TH0100X | Health Service | 1758 | WI |
N | 103TM1800X | Intellectual & Developmental Disabilities | 1758 | WI |
N | 103TP2701X | Group Psychotherapist | 1758 | WI |
NPI | 1508914771 |
---|---|
Provider Name | Dr. Jeffrey Allen Adamczak |
First Address | Oak Creek, WI 53154-3150 |
Second Address | Racine, WI 53406-3938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2007 |
Last Update Date | 08/07/2007 |