Provider Demographics
NPI:1467703223
Name:GRAPENGIESER, JONATHAN T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:T
Last Name:GRAPENGIESER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:T
Other - Last Name:GRAPENGIESER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1126 S 70TH ST
Mailing Address - Street 2:SUITE S507
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3151
Mailing Address - Country:US
Mailing Address - Phone:414-475-2788
Mailing Address - Fax:414-476-8695
Practice Address - Street 1:1126 S 70TH ST
Practice Address - Street 2:SUITE S507
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3151
Practice Address - Country:US
Practice Address - Phone:414-475-2788
Practice Address - Fax:414-476-8695
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3170-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical