Provider Demographics
NPI:1154766004
Name:LISOWSKI, SUZANNE J (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:J
Last Name:LISOWSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 S KINNICKINNIC AVE
Mailing Address - Street 2:2230 S KINNICKINNIC AVE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1330
Mailing Address - Country:US
Mailing Address - Phone:414-769-1989
Mailing Address - Fax:414-769-1989
Practice Address - Street 1:2230 S KINNICKINNIC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1330
Practice Address - Country:US
Practice Address - Phone:414-769-1989
Practice Address - Fax:414-769-1989
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
899-57103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic