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General NPI Number Information
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NPI Number | 1316766082
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Entity Type | Organization
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Legal Business Name | SUN PRAIRIE PSYCHOLOGICAL LLC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 750 WINDSOR ST STE 208
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-2149
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Country | US
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Telephone | 608-825-6663
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Fax | 608-825-6946
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Provider Business Mailing Address
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Address Line | 750 WINDSOR ST STE 208
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-2149
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Country | US
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Telephone | 608-825-6663
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Fax | 608-825-6946
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MINDY E HASELEU
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Credential | PSYD
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Telephone | 920-988-4520
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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 |
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License Number State |
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