| Vibrant Child Psychology Services Llc | |
|
10150 W National Ave Ste 315 West Allis WI 53227-2153 | |
| (262) 668-8870 | |
| (414) 310-0560 |
| Full Name | Vibrant Child Psychology Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 10150 W National Ave Ste 315, West Allis, Wisconsin |
| Authorized Official Name and Position | Jill Delie (OWNER) |
| Authorized Official Contact | 4146871285 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vibrant Child Psychology Services Llc 2945 N 84th St Milwaukee WI 53222-4705 Ph: (414) 687-1285 | Vibrant Child Psychology Services Llc 10150 W National Ave Ste 315 West Allis WI 53227-2153 Ph: (262) 668-8870 |
| NPI Number | 1104648369 |
|---|---|
| Provider Enumeration Date | 10/29/2024 |
| Last Update Date | 10/29/2024 |
| Certification Date | 10/25/2024 |
| Medicare PECOS PAC ID | 2163957820 |
|---|---|
| Medicare Enrollment ID | O20241119001865 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104648369 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Jill Nicole Delie |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437718624 PECOS PAC ID: 9335674001 Enrollment ID: I20241119002059 |
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