1134656820 NPI number — DR. JOHN PAUL PH.D., L.P.C.

Table of content: DR. JOHN PAUL PH.D., L.P.C. (NPI 1134656820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134656820 NPI number — DR. JOHN PAUL PH.D., L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAUL
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., L.P.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134656820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2000
Provider Second Line Business Mailing Address:
UNIVERSITY OF WISCONSIN-SUPERIOR, SWENSON 2060
Provider Business Mailing Address City Name:
SUPERIOR
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54880-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-394-8151
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 N 34TH ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUPERIOR
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54880-4476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-464-3057
Provider Business Practice Location Address Fax Number:
888-724-4599
Provider Enumeration Date:
05/12/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  4417 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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