Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 3267 | WI |
NPI | 1073813804 |
---|---|
Provider Name | Michelle R Gryczkowski |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53719-1176 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2010 |
Last Update Date | 10/11/2015 |