John, Derek Jeremy

John, Derek Jeremy is an individual health care provider with primary practice located at 631 Forest St , Wausau WI 54403-5524. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. John, Derek Jeremy can be contacted via phone (715) 842-0944.

Contact Information

Primary practice address
631 Forest St Wausau WI 54403-5524
Phone: (715) 842-0944
Fax: (715) 845-6477
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 2306-057 Wisconsin

Profile Details

NPI number 1912926601
LBN Legal business name John, Derek Jeremy
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912926601 NPPES
Wisconsin Other 87249 SECURITY HEALTH INSURANCE
Wisconsin Other 332603 SECURITY HEALTH INSURANCE
Wisconsin Other 2187795 SECURITY HEALTH INSURANCE

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