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General NPI Number Information
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NPI Number | 1346732872
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Entity Type | Organization
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Legal Business Name | FORTITUDE PSYCHOLOGY LLC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 6314 ODANA RD STE E
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City | MADISON
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State | WI
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Zip | 53719-1129
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Country | US
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Telephone | 608-381-1125
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Fax |
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Provider Business Mailing Address
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Address Line | 6314 ODANA RD STE E
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City | MADISON
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State | WI
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Zip | 53719-1129
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Country | US
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Telephone | 608-381-1125
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JAIME VOSS
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Credential | PSY.D.
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Telephone | 608-381-1125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2976
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License Number State | WI
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