Healthcare Provider Details

I. General information

NPI: 1063453835
Provider Name (Legal Business Name): DONNA MARIE ULTEIG LCSW, DCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 MARSHALL CT PSSC
MADISON WI
53705-2255
US

IV. Provider business mailing address

802 BUTTERNUT RD
MADISON WI
53704-6006
US

V. Phone/Fax

Practice location:
  • Phone: 608-238-9354
  • Fax: 608-238-7675
Mailing address:
  • Phone: 608-249-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number391-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: