Provider Demographics
NPI:1487676474
Name:WARRIOR, JEAN ANN (PH D)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ANN
Last Name:WARRIOR
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1176
Mailing Address - Country:US
Mailing Address - Phone:608-935-2838
Mailing Address - Fax:608-935-9227
Practice Address - Street 1:1118 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1176
Practice Address - Country:US
Practice Address - Phone:608-935-2838
Practice Address - Fax:608-935-9227
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1165057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
52612210115OtherDEAN CARE FACILITY PROVID
391612972011OtherBCBS FACILITY #
WI4220040039079100Medicaid
WI447250008OtherMEDICARE RICHLAND COUNTY H&HS
849700001OtherDODGEVILLE
WI447250008OtherMEDICARE RICHLAND COUNTY H&HS