Healthcare Provider Details

I. General information

NPI: 1396586806
Provider Name (Legal Business Name): VISHAL ILESH PATEL APSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S BLOUNT ST
MADISON WI
53703-4664
US

IV. Provider business mailing address

179 W WILSON ST APT 414
MADISON WI
53703-5108
US

V. Phone/Fax

Practice location:
  • Phone: 608-405-5111
  • Fax:
Mailing address:
  • Phone: 262-321-9053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number134865-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: