Healthcare Provider Details

I. General information

NPI: 1104184142
Provider Name (Legal Business Name): HURD COUNSELING AND EDUCATIONAL PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RAYOVAC DRIVE
MADISON WI
53711
US

IV. Provider business mailing address

7580 VALLEY WOODS CT
VERONA WI
53593-9569
US

V. Phone/Fax

Practice location:
  • Phone: 608-228-0750
  • Fax:
Mailing address:
  • Phone: 608-228-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2890-057
License Number StateWI

VIII. Authorized Official

Name: DR. HEATHER DOESCHER HURD
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 608-228-0750