Healthcare Provider Details

I. General information

NPI: 1518277466
Provider Name (Legal Business Name): HEATHER DOESCHER HURD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 SCHROEDER RD
MADISON WI
53711-2401
US

IV. Provider business mailing address

8530 GREENWAY BLVD UNIT 310
MIDDLETON WI
53562-4607
US

V. Phone/Fax

Practice location:
  • Phone: 608-441-0123
  • Fax:
Mailing address:
  • Phone: 612-850-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2890-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: