MEDICARE: DR. TORRIA VAN BUREN PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3208-57	WI

General Provider Information

NPI Number	:	1053761742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TORRIA VAN BUREN PSY.D

Provider Business Mailing Address
First Line	:	200 S MADISON ST
Second Line	:
City	:	WAUPUN
State	:	WI
Zip	:	53963-2000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S MADISON ST
Second Line	:
City	:	WAUPUN
State	:	WI
Zip	:	53963-2000
Country	:	US
Telephone Number	:	920-324-5571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	10/06/2016

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