Basic Information
| Provider Information | |||||||||
| NPI: | 1790834109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JURENEC | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9120 W HAMPTON AVE | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532254960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144649777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9455 W WATERTOWN PLANK RD | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142576995 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 09/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1153-057 | WI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | 1593-057 | WI | N | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.