Healthcare Provider Details

I. General information

NPI: 1790891737
Provider Name (Legal Business Name): SANDRA LEE EUGSTER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 PRICE PL SUITE 108
MADISON WI
53705-3299
US

IV. Provider business mailing address

313 PRICE PL SUITE 108
MADISON WI
53705-3299
US

V. Phone/Fax

Practice location:
  • Phone: 608-233-2477
  • Fax: 608-233-8480
Mailing address:
  • Phone: 608-233-2477
  • Fax: 608-233-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2043-057
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2043-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: