Healthcare Provider Details

I. General information

NPI: 1952120396
Provider Name (Legal Business Name): BETHANY CONTENT LERAAS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 HIGHLAND AVE
MADISON WI
53792-0002
US

IV. Provider business mailing address

2801 POST RD
MADISON WI
53713-3417
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-7337
  • Fax:
Mailing address:
  • Phone: 320-761-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: