| Myles Tonnacliff Ph.d, Llc | |
|
W62n248 Washington Ave Suite 208 Cedarburg WI 53012-2768 | |
| (262) 618-2856 | |
| Not Available |
| Full Name | Myles Tonnacliff Ph.d, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | W62n248 Washington Ave, Cedarburg, Wisconsin |
| Authorized Official Name and Position | Myles D Tonnacliff (LICESED PSYCHOLOGIST- OWNER) |
| Authorized Official Contact | 2626182856 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Myles Tonnacliff Ph.d, Llc W62n248 Washington Ave Suite 208 Cedarburg WI 53012-2768 Ph: (414) 617-2663 | Myles Tonnacliff Ph.d, Llc W62n248 Washington Ave Suite 208 Cedarburg WI 53012-2768 Ph: (262) 618-2856 |
| NPI Number | 1235666017 |
|---|---|
| Provider Enumeration Date | 05/11/2017 |
| Last Update Date | 05/11/2017 |
| Medicare PECOS PAC ID | 6103185186 |
|---|---|
| Medicare Enrollment ID | O20180119001656 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235666017 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 2163-57 (Wisconsin) | Primary |
| Provider Name | Myles David Tonnacliff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942335260 PECOS PAC ID: 3577669753 Enrollment ID: I20070504000046 |
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