MEDICARE: SONAS BEHAVIORAL HEALTH LLC

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	103TC0700X	Clinical Psychologist	2400-057	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1841370384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONAS BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	6402 ODANA RD
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1123
Country	:	US
Telephone Number	:	608-204-6076
Fax Number	:	608-204-9568

Provider Business Practice Location Address
First Line	:	6402 ODANA RD
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1123
Country	:	US
Telephone Number	:	608-204-6076
Fax Number	:	608-204-9568

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. DOLORES KLUPPEL VETTER
Credential	:	PH.D.
Telephone Number	:	608-204-6076

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/30/2015

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