Provider Demographics
NPI:1073722211
Name:SUMMIT PSYCHOLOGY CLINIC SC
Entity Type:Organization
Organization Name:SUMMIT PSYCHOLOGY CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-258-8488
Mailing Address - Street 1:933 N MAYFAIR RD
Mailing Address - Street 2:STE 303
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-258-8488
Mailing Address - Fax:414-258-8838
Practice Address - Street 1:933 N MAYFAIR RD
Practice Address - Street 2:STE 303
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-258-8488
Practice Address - Fax:414-258-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)