Modell, Craig Alan

Modell, Craig Alan is an individual health care provider with primary practice located at 10229 W Greenfield Ave , West Allis WI 53214. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Modell, Craig Alan can be contacted via phone (414) 453-6330.

Contact Information

Primary practice address
10229 W Greenfield Ave West Allis WI 53214
Fax: (414) 453-6523
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 696057 Wisconsin

Profile Details

NPI number 1366552887
LBN Legal business name Modell, Craig Alan
Credentials PHD PSYCHOLOGIST
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 30th, 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 1366552887 NPPES
Wisconsin MEDICAID 39097200

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