| Doctor Name: | JAMES JEFFREY CRISCO |
| NPI Number: | 1013172600 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 613-057 |
| Business Practice Address: | 3636 N 124th St Suite 200 Wauwatosa, WI - 532222125 |
| Business Phone Number: | 4144769755 |
| Business Fax Number: | 4144763413 |
| Mailing Address: | 3636 N 124th St, Suite 200 WAUWATOSA |
| State: | WI |
| Postal Code: | 532222125 |
| Phone Number: | 4144769755 |
| Fax Number: | 4144763413 |
| NPI Enumeration Date: | 07/23/2008 |
| NPI Last Update Date: | 04/22/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 613-057 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |