Provider Demographics
NPI:1669549960
Name:EMILEY, STEPHEN FRANCIS (PHD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:FRANCIS
Last Name:EMILEY
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 1:5900 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE A-230
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4503
Mailing Address - Country:US
Mailing Address - Phone:414-961-0030
Mailing Address - Fax:262-375-3368
Practice Address - Street 1:5900 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE A-230
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4503
Practice Address - Country:US
Practice Address - Phone:414-961-0030
Practice Address - Fax:262-375-3368
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI576-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39056500Medicaid