1760649354 NPI number — RICHARD A HOHFELER III PSYD, S.C.

Table of content: (NPI 1760649354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760649354 NPI number — RICHARD A HOHFELER III PSYD, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD A HOHFELER III PSYD, S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1760649354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4329 N SAWYER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCONOMOWOC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53066-4551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-569-8399
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10045 W LISBON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUWATOSA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53222-2446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-351-7151
Provider Business Practice Location Address Fax Number:
414-393-1640
Provider Enumeration Date:
05/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOHFELER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
AUGUST
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
262-569-8399

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1295 , 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)

  • Identifier: 41277 . This is a "NATIONAL REGISTER FOR HEALTH SERVICE PROVIDERS IN PSYCHOLOGY" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 39077400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1295 . This is a "PSYCHOLOGY LICENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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