Healthcare Provider Details

I. General information

NPI: 1609712074
Provider Name (Legal Business Name): BLUEDOT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 WILD OAK RD
HARTLAND WI
53029-1217
US

IV. Provider business mailing address

559 WILD OAK RD
HARTLAND WI
53029-1217
US

V. Phone/Fax

Practice location:
  • Phone: 414-902-3852
  • Fax: 414-340-3227
Mailing address:
  • Phone: 414-902-3852
  • Fax: 414-340-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEIRDRE LOUISE CARDOSA
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: DNP- PMHNP
Phone: 262-454-2505