Healthcare Provider Details

I. General information

NPI: 1750931580
Provider Name (Legal Business Name): CHRISTINA ESCUDER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 LANDMARK PL STE 215
MADISON WI
53713-4248
US

IV. Provider business mailing address

207 S OWEN DR
MADISON WI
53705-5036
US

V. Phone/Fax

Practice location:
  • Phone: 608-492-0296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3721-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: