Healthcare Provider Details

I. General information

NPI: 1720095169
Provider Name (Legal Business Name): MICHAEL NEILL SWEETNAM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 GREENWAY BLVD STE 500
MIDDLETON WI
53562-3529
US

IV. Provider business mailing address

8383 GREENWAY BLVD STE 500
MIDDLETON WI
53562-3529
US

V. Phone/Fax

Practice location:
  • Phone: 608-274-0355
  • Fax: 608-274-5546
Mailing address:
  • Phone: 608-274-0355
  • Fax: 608-274-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number778-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: