=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285931675
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEAN SANER, PSY.D., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2011
-----------------------------------------------------
Last Update Date | 02/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 W SOUTH ST
-----------------------------------------------------
City | VIROQUA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54665-1943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-637-2511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 122 W SOUTH ST P.O. BOX 206
-----------------------------------------------------
City | VIROQUA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54665-1943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-637-2511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. DEAN SANER
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 608-637-2511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 2089057
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------