Healthcare Provider Details

I. General information

NPI: 1326005935
Provider Name (Legal Business Name): PETER A WILLIAMSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 FISH HATCHERY RD
MADISON WI
53715-1911
US

IV. Provider business mailing address

1313 FISH HATCHERY RD
MADISON WI
53715-1911
US

V. Phone/Fax

Practice location:
  • Phone: 608-252-8000
  • Fax: 608-283-7351
Mailing address:
  • Phone: 608-252-8000
  • Fax: 608-283-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1088-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: