=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174601389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET A. DENNISON PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 10/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 W STATE ST
-----------------------------------------------------
City | MAUSTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53948-1354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-847-7924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 193
-----------------------------------------------------
City | MAUSTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53948-0193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-847-7924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 1555-125
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2394-057
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------