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General NPI Number Information
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NPI Number | 1043406978
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Entity Type | Organization
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Legal Business Name | CHAMELEON GROUP
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 1210 FOURIER DRIVE SUITE #100
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City | MADISON
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State | WI
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Zip | 53717-1969
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Country | US
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Telephone | 608-662-9327
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Fax | 608-662-9041
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Provider Business Mailing Address
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Address Line | 1210 FOURIER DRIVE SUITE #100
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City | MADISON
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State | WI
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Zip | 53717-1969
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Country | US
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Telephone | 608-662-9327
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Fax | 608-662-9041
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Authorized Official
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Title or Position | DIRECTOR OF BILLING
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Name | KIM LAUREE SCHUTT-CHARDON
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Credential |
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Telephone | 608-662-9327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | HFS 61.91
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License Number State | WI
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