Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 2721-057 | WI |
NPI | 1013176288 |
---|---|
Provider Name | Dr. Patricia K. Marik |
First Address | Milwaukee, WI 53201-1997 |
Second Address | Wauwatosa, WI 53226-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 08/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013176288 | (05) | WI |