Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 350 | WI |
NPI | 1114093929 |
---|---|
Provider Name | Fredrick O Beck |
First Address | Sheboygan, WI 53083 |
Second Address | Sheboygan, WI 53083-3839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 08/07/2007 |