Provider Demographics
NPI:1780638429
Name:JUERN, JOHN F (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:JUERN
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 1:3333 N MAYFAIR RD
Mailing Address - Street 2:SUITE #210
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3219
Mailing Address - Country:US
Mailing Address - Phone:414-778-1530
Mailing Address - Fax:414-778-1531
Practice Address - Street 1:3333 N MAYFAIR RD
Practice Address - Street 2:SUITE #210
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-3219
Practice Address - Country:US
Practice Address - Phone:414-778-1530
Practice Address - Fax:414-778-1531
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1119-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39076800Medicaid