Healthcare Provider Details

I. General information

NPI: 1184746828
Provider Name (Legal Business Name): UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E OLIN AVE STE 255
MADISON WI
53713
US

IV. Provider business mailing address

122 E OLIN AVE STE 255
MADISON WI
53713-1468
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-9438
  • Fax: 608-263-4681
Mailing address:
  • Phone: 608-265-9438
  • Fax: 608-263-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENNETH MOUNT
Title or Position: ASSOCIATE DEAN
Credential:
Phone: 608-263-4938