Provider Demographics
NPI:1366466427
Name:SPEAKER, THOMAS (PHD, LCSW, CADC III)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SPEAKER
Suffix:
Gender:M
Credentials:PHD, LCSW, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 N JANACEK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6102
Mailing Address - Country:US
Mailing Address - Phone:262-641-9050
Mailing Address - Fax:262-641-9126
Practice Address - Street 1:2314 N GRANDVIEW BLVD
Practice Address - Street 2:SUITES 301 AND 110
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1675
Practice Address - Country:US
Practice Address - Phone:262-524-9416
Practice Address - Fax:262-524-9434
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1908-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39184300Medicaid