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General NPI Number Information
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NPI Number | 1982063897
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Entity Type | Organization
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Legal Business Name | CDL PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 02/19/2016
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Last Update Date | 09/05/2016
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Provider Practice Location Address
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Address Line | 410 JOHNSON PKWY
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City | HAMMOND
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State | WI
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Zip | 54015-9678
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Country | US
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Telephone | 715-497-7230
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Fax | 715-600-9041
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Provider Business Mailing Address
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Address Line | 410 JOHNSON PKWY
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City | HAMMOND
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State | WI
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Zip | 54015-9678
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Country | US
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Telephone | 715-497-7230
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Fax | 715-600-9023
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. GREG WILLIAM ANDERSON
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Credential | PSY.D.
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Telephone | 715-497-7230
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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 | 3349-57
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License Number State | WI
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