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General NPI Number Information
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NPI Number | 1982064366
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Entity Type | Organization
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Legal Business Name | MADISON NEUROPSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 6510 GRAND TETON PLZ STE 102 STE 24
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City | MADISON
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State | WI
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Zip | 53719
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Country | US
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Telephone | 608-841-1606
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Fax | 608-492-2573
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Provider Business Mailing Address
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Address Line | 6510 GRAND TETON PLZ STE 102
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City | MADISON
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State | WI
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Zip | 53719-1031
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Country | US
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Telephone | 608-841-1606
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Fax | 608-492-2573
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Authorized Official
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Title or Position | OWNER
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Name | DR. SARAH E PORTER
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Credential | PSYD
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Telephone | 608-841-1606
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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 | 3198-57
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 3198-57
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License Number State | WI
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