Provider Demographics
NPI:1295990075
Name:VOELZ, MALCOLM J (PHD)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:J
Last Name:VOELZ
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 1:2600 STEWART AVE
Mailing Address - Street 2:SUITE # 272-4
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4148
Mailing Address - Country:US
Mailing Address - Phone:715-842-4091
Mailing Address - Fax:
Practice Address - Street 1:2600 STEWART AVE
Practice Address - Street 2:SUITE # 272-4
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4148
Practice Address - Country:US
Practice Address - Phone:715-842-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI639-057103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist