Healthcare Provider Details

I. General information

NPI: 1023921921
Provider Name (Legal Business Name): INTEGRATIVE PSYCHIATRY OF WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 ATWOOD AVE STE 204
MADISON WI
53704-5655
US

IV. Provider business mailing address

2722 HOMESTEAD RD
MADISON WI
53711-4021
US

V. Phone/Fax

Practice location:
  • Phone: 608-516-0759
  • Fax: 608-305-8639
Mailing address:
  • Phone: 608-516-0759
  • Fax: 608-305-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH MOORE
Title or Position: OWNER
Credential: MD
Phone: 608-516-0759