BRIAN D MAMOTT Clinical Psychologist License verification

Business Entity

NOT RENEWED

License Type

Clinical Psychologist

Description

CLINICAL PSYCHOLOGIST

License Number

071005752

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

Last Name

MAMOTT

Business Name

BRIAN D MAMOTT

Original Issue Date

10/14/1998

Effective Date

09/29/2014

Expiration Date

09/30/2016

City

FREEPORT

State

Zip

61032

County

STEPHENSON

Ever Disciplined

LastModifiedDate

11/26/2016

Case Number

2014009029

Action

Reprimand

Discipline Start Date

04/09/2015

Discipline Reason

based on his self-reported sister state discipline in Wisconsin.