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General NPI Number Information
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NPI Number | 1740440924
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Entity Type | Organization
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Legal Business Name | SCOTT L FENTON, PSYD, LLC
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 5900 MONONA DR STE 408
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City | MONONA
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State | WI
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Zip | 53716-3561
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Country | US
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Telephone | 608-628-3963
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Fax | 608-501-0978
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Provider Business Mailing Address
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Address Line | 5900 MONONA DR STE 408
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City | MONONA
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State | WI
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Zip | 53716-3561
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Country | US
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Telephone | 608-628-3963
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Fax | 608-501-0978
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | SCOTT L FENTON
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Credential | PSYD
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Telephone | 608-628-3963
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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 | 2531057
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License Number State | WI
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