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NPI Code Detail

MEDICARE: TED D IZYDOR LPC

MEDICARE: TED D IZYDOR LPC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor14034-132WI
2101YP2500XProfessional Counselor2878WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275501140
Entity Type Code : Individual
Provider Name (Legal Business Name) : TED D IZYDOR LPC
Provider Business Mailing Address
First Line : 128 E OLIN AVE
Second Line : SUITE 100
City : MADISON
State : WI
Zip : 53713-1467
Country : US
Telephone Number : 608-252-1320
Fax Number : 608-252-1333
Provider Business Practice Location Address
First Line : 128 E OLIN AVE
Second Line : SUITE 100
City : MADISON
State : WI
Zip : 53713-1467
Country : US
Telephone Number : 608-252-1320
Fax Number : 608-252-1333
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 10/21/2011

Similar Medicare Providers

1033072111 — KAITLIN PAIGE WELSH MSW, CAPSW
Practice Location Address:
128 E OLIN AVE STE 100
MADISON, WI
53713-1467
Practice Phone: 608-252-1320
Practice Fax: 608-252-1333
1649349648 — MS. ALTHEA W CHANG MS LMFT
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1649339748 — MR. MICHAEL ERWIN BEILKE LMFT
Practice Location Address:
128 E OLIN AVE , SUITE 100
MADISON, WI
53713-1467
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Practice Fax: 608-252-1333
1275694093 — MS. LINDA SHEEHY MS LPC
Practice Location Address:
128 E OLIN AVE , SUITE 100
MADISON, WI
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1881806198 — FAMILY SERVICE MADISON INC
Practice Location Address:
128 E OLIN AVE , SUITE 100
MADISON, WI
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1508072182 — ALLISON ADELE HILL-SLAVIN LMFT
Practice Location Address:
128 E OLIN AVE , SUITE 100
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53713-1467
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Practice Fax: 608-252-1328

Directions to “ TED D IZYDOR LPC” Practice Location

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