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General NPI Number Information
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NPI Number | 1902098957
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC SERVICES SC
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 2727 MARSHALL CT
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City | MADISON
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State | WI
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Zip | 53705-2255
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Country | US
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Telephone | 608-238-9354
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Fax | 608-238-7675
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Provider Business Mailing Address
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Address Line | 2727 MARSHALL CT
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City | MADISON
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State | WI
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Zip | 53705-2255
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Country | US
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Telephone | 608-238-9354
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Fax | 608-238-7675
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES JAMES HODULIK
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Credential | MD
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Telephone | 608-238-9354
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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 | 1898-057
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1064-057
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 522-123
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 22400-020
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1085-123
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License Number State | WI
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3257-123
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License Number State | WI
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Taxonomy #7
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2284-057
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License Number State | WI
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Taxonomy #8
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7213-123
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License Number State | WI
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Taxonomy #9
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 504-123
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License Number State | WI
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Taxonomy #10
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2155-057
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License Number State | WI
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Taxonomy #11
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 391-123
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License Number State | WI
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Taxonomy #12
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1993-057
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License Number State | WI
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Taxonomy #13
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 920-057
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License Number State | WI
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Taxonomy #14
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 41061-021
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License Number State | WI
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