Healthcare Provider Details

I. General information

NPI: 1982137147
Provider Name (Legal Business Name): DANIEL DICKSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5618 ODANA RD
MADISON WI
53719-1208
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-232-3171
  • Fax: 608-262-9246
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3462
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: