Basic Information
| Provider Information | |||||||||
| NPI: | 1609857770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOJIS | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 N JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532022602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142251300 | ||||||||
| FaxNumber: | 4142251346 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 N JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532022602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142251300 | ||||||||
| FaxNumber: | 4142251346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1581 | WI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 39110800 | 05 | WI | MEDICAID |