Zylstra, Marc W

Zylstra, Marc W is an individual health care provider with primary practice located at 2525 N Mayfair Rd Suite 200, Wauwatosa WI 53226-1403. He recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Health Service, Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Group Psychotherapy. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Zylstra, Marc W can be contacted via phone (414) 476-8183.

Contact Information

Primary practice address
2525 N Mayfair Rd Suite 200 Wauwatosa WI 53226-1403
Phone: (414) 476-8183
Fax: (414) 476-8465
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 1817-057 Wisconsin
Behavioral Health & Social Service Providers / Health Service 103TH0100X 43715 Wisconsin
Behavioral Health & Social Service Providers / Psychologist 103T00000X 1817-057 Wisconsin
Behavioral Health & Social Service Providers / Group Psychotherapy 103TP2701X 1817-057 Wisconsin

Profile Details

NPI number 1295847002
LBN Legal business name Zylstra, Marc W
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2006
Last updated Jul 9th, 2007 - about 17 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 1295847002 NPPES
Wisconsin MEDICAID 21280000
Wisconsin MEDICAID 39640900

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