Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 4147-123 | WI |
NPI | 1255408811 |
---|---|
Provider Name | Paul F Strand |
First Address | Green Bay, WI 54301-4239 |
Second Address | Green Bay, WI 54301-4239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39706700 | (05) | WI |