Provider Demographics
NPI:1609857770
Name:KOJIS, JOAN (PHD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:KOJIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2602
Mailing Address - Country:US
Mailing Address - Phone:414-225-1300
Mailing Address - Fax:414-225-1346
Practice Address - Street 1:1300 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2602
Practice Address - Country:US
Practice Address - Phone:414-225-1300
Practice Address - Fax:414-225-1346
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1581103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39110800Medicaid