Provider Demographics
NPI:1073613105
Name:FOKER, GREGORY ROBERT (PHD)
Entity type:Individual
Prefix:PROF
First Name:GREGORY
Middle Name:ROBERT
Last Name:FOKER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:ROBERT
Other - Last Name:FOKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:155 E CAPITOL DR STE 6A
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2143
Mailing Address - Country:US
Mailing Address - Phone:262-226-7301
Mailing Address - Fax:
Practice Address - Street 1:155 E CAPITOL DR STE 6A
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2143
Practice Address - Country:US
Practice Address - Phone:262-226-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
WI654-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY39709400Medicaid