Provider Demographics
NPI:1629174743
Name:BREITENSTEIN, JOSEPH LOUIS (PHD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LOUIS
Last Name:BREITENSTEIN
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 1:603 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2527
Mailing Address - Country:US
Mailing Address - Phone:563-419-1124
Mailing Address - Fax:563-382-4699
Practice Address - Street 1:603 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2527
Practice Address - Country:US
Practice Address - Phone:563-419-1124
Practice Address - Fax:563-382-4699
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1663103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical