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NPI Code Detail

MEDICARE: MARILYN R DEAN PSYD

MEDICARE:   MARILYN R DEAN  PSYD
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
1103T00000XPsychologist1161WI

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 : 1790892057
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN R DEAN PSYD
Provider Business Mailing Address
First Line : C3800 HEARTLAND HILLS RD
Second Line :
City : STRATFORD
State : WI
Zip : 54484-9488
Country : US
Telephone Number : 715-223-7282
Fax Number :
Provider Business Practice Location Address
First Line : C3800 HEARTLAND HILLS RD
Second Line :
City : STRATFORD
State : WI
Zip : 54484-9488
Country : US
Telephone Number : 715-223-7282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2006
Last Update Date : 02/15/2012

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Directions to “ MARILYN R DEAN PSYD” Practice Location

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