Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1230-057 | WI |
N | 103T00000X | Psychologist | 1230-057 | WI |
N | 103G00000X | Clinical Psychologist | 1230-057 | WI |
N | 103TC0700X | Clinical Psychologist | 1230-057 | WI |
N | 103TH0100X | Health Service | 35007 | WI |
N | 103TP2701X | Group Psychotherapist | 1230-057 | WI |
NPI | 1023194297 |
---|---|
Provider Name | Dr. John R Galbraith |
First Address | Wauwatosa, WI 53226-1403 |
Second Address | Wauwatosa, WI 53226-1403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21280000 | (05) | WI |
39041800 | (05) | WI |