Provider Demographics
NPI:1063250520
Name:HOMBSCH, OWEN WILLIAM
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:WILLIAM
Last Name:HOMBSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1412
Mailing Address - Country:US
Mailing Address - Phone:920-253-8521
Mailing Address - Fax:
Practice Address - Street 1:2717 N GRANDVIEW BLVD STE 112
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1660
Practice Address - Country:US
Practice Address - Phone:262-793-0994
Practice Address - Fax:888-867-0673
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional