Healthcare Provider Details

I. General information

NPI: 1700838836
Provider Name (Legal Business Name): SYLVIA J. DENNISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 5TH AVE
ANTIGO WI
54409-2710
US

IV. Provider business mailing address

110 E 5TH AVE
ANTIGO WI
54409-2710
US

V. Phone/Fax

Practice location:
  • Phone: 715-623-2351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number44166-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number44166-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: