Provider Demographics
NPI:1073659801
Name:BUIKEMA, JEFFREY KARL (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:KARL
Last Name:BUIKEMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5973 COUNTY ROAD B
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-2975
Mailing Address - Country:US
Mailing Address - Phone:608-784-9645
Mailing Address - Fax:608-783-0264
Practice Address - Street 1:W5973 COUNTY ROAD B
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-2975
Practice Address - Country:US
Practice Address - Phone:608-784-9645
Practice Address - Fax:608-783-0264
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI229-124106H00000X
IA00170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist