is a Clinical in Beaver Dam, Wisconsin. practices all healthcare services and medical treatments related to Clinical. The NPI Number for is 1821049412. The last update date is .
's current location address is 200 Front Street, Beaver Dam, Wisconsin. You can contact this provider via phone number 9208852780 and fax number 9208852788. The mailing address for is 200 Front Street, Beaver Dam, Wisconsin. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 200 Front Street, Beaver Dam, Wisconsin |
| Phone Number | 9208852780 |
| Fax Number | 9208852788 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1821049412 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 200 Front Street |
|---|---|
| City | Beaver Dam |
| State | Wisconsin (WI) |
| Post Code | 53916 |
| Phone Number | 9208852780 |
| Fax Number | 9208852788 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 103Tc0700X |
| Licence No | 1012057 |
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Definition: A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 39077100 | WI | -- |
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