Healthcare Provider Details

I. General information

NPI: 1336989748
Provider Name (Legal Business Name): MADELINE PFLUM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE JOHNSON MS

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

IV. Provider business mailing address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-4000
  • Fax: 608-824-4938
Mailing address:
  • Phone: 608-824-4000
  • Fax: 608-824-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4169-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: