Provider Demographics
NPI:1730744368
Name:I5 CONSULTING, LLC
Entity type:Organization
Organization Name:I5 CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-232-0077
Mailing Address - Street 1:9484 N FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1321
Mailing Address - Country:US
Mailing Address - Phone:414-232-0077
Mailing Address - Fax:
Practice Address - Street 1:6100 N 42ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-3560
Practice Address - Country:US
Practice Address - Phone:414-232-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WII04292019001652Medicaid