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General NPI Number Information
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NPI Number | 1134306103
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PSYCHOLOGICAL SERVICES, SC
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 441 MILWAUKEE AVE STE 2
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City | BURLINGTON
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State | WI
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Zip | 53105-1230
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Country | US
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Telephone | 262-767-0440
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Fax | 262-767-0777
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Provider Business Mailing Address
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Address Line | 441 MILWAUKEE AVE STE 2
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City | BURLINGTON
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State | WI
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Zip | 53105-1230
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Country | US
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Telephone | 262-767-0440
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Fax | 262-767-0777
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. DEAN EDWARD STOLLDORF
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Credential | PHD
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Telephone | 262-767-0440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1746
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License Number State | WI
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