OrganizationActive
Adult & Adolescent Trt. Ctr.
NPI 1124286430 · Psychiatry Physician · Glendale, WI
Provider details
- NPI number
- 1124286430
- Entity type
- Organization
- Primary specialty
- Psychiatry PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Jeffrey Wilson, President
- License
- 15620 (WI)
Practice location
5225 N Ironwood Rd
S102
Glendale, WI 53217-4909
Phone: (414) 332-0552
Fax: (414) 962-4356
Mailing address
5225 N Ironwood Rd
Glendale, WI 53217-4909
Registry dates
- Enumerated
- 2008-05-23
- Last updated
- 2008-05-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.