Provider Demographics
NPI:1083778781
Name:HIGBIE, DOUGLAS RALPH (PHD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:RALPH
Last Name:HIGBIE
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 1:3149 W COLONY DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2161
Mailing Address - Country:US
Mailing Address - Phone:414-325-3698
Mailing Address - Fax:
Practice Address - Street 1:634 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204
Practice Address - Country:US
Practice Address - Phone:414-383-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1934-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist