Provider Demographics
NPI:1174625461
Name:VERWERT, ROBERT H (PH D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:VERWERT
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:H
Other - Last Name:VERWOERT
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2717 N GRANDVIEW BLVD
Mailing Address - Street 2:#303 STRESS MANAGEMENT CLINIC
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1660
Mailing Address - Country:US
Mailing Address - Phone:262-544-6486
Mailing Address - Fax:262-544-6377
Practice Address - Street 1:2717 N GRANDVIEW BLVD
Practice Address - Street 2:#303 STRESS MANAGEMENT CLINIC
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1660
Practice Address - Country:US
Practice Address - Phone:262-544-6486
Practice Address - Fax:262-544-6377
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1218057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39073800Medicaid