Provider Demographics
NPI:1902187040
Name:AZIZI, ASAL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ASAL
Middle Name:
Last Name:AZIZI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E UPHAM ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1543
Mailing Address - Country:US
Mailing Address - Phone:715-502-4642
Mailing Address - Fax:
Practice Address - Street 1:216 E UPHAM ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1543
Practice Address - Country:US
Practice Address - Phone:715-502-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24063103TC0700X
WI2978-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical