Provider Demographics
NPI:1851461313
Name:JUNCKER, BRIAN D (PHD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:JUNCKER
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 1:600 HIGHLAND AVE
Mailing Address - Street 2:OFFICE E2.206
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-2424
Mailing Address - Country:US
Mailing Address - Phone:608-263-0432
Mailing Address - Fax:608-263-1575
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:OFFICE E2.206
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:608-263-0432
Practice Address - Fax:608-263-1575
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2619-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2619-057OtherHEALTH PSYCHOLOGIST