Provider Demographics
NPI:1396568895
Name:VICE-RESHEL, JENNIFER MOORE (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MOORE
Last Name:VICE-RESHEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7330 N MOHAWK RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3454
Mailing Address - Country:US
Mailing Address - Phone:330-256-4143
Mailing Address - Fax:
Practice Address - Street 1:1250 N 113TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:WAWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3209
Practice Address - Country:US
Practice Address - Phone:262-432-6600
Practice Address - Fax:424-432-6604
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist