Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3505 | WI |
Y | 103T00000X | Psychologist | 3505 | WI |
NPI | 1003335134 |
---|---|
Provider Name | Jeralee Briggs |
First Address | Wauwatosa, WI 53213-3244 |
Second Address | Milwaukee, WI 53295-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2017 |
Last Update Date | 09/09/2017 |