Provider Demographics
NPI:1932105392
Name:HISCHKE, DARRELL LINN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:LINN
Last Name:HISCHKE
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 1:2401 N MAYFAIR RD
Mailing Address - Street 2:STE 110
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1408
Mailing Address - Country:US
Mailing Address - Phone:414-774-4288
Mailing Address - Fax:
Practice Address - Street 1:2401 N MAYFAIR RD
Practice Address - Street 2:STE 110
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1408
Practice Address - Country:US
Practice Address - Phone:414-774-4288
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1646057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist