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General NPI Number Information
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NPI Number | 1982762670
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Entity Type | Individual
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Provider Name | DALE ANTHONY BESPALEC PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9120 W HAMPTON AVE SUITE 212
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City | MILWAUKEE
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State | WI
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Zip | 53225-4960
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Country | US
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Telephone | 414-464-9777
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Fax | 414-358-5590
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Provider Business Mailing Address
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Address Line | 1911 MARYGLADE DR
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City | GRAFTON
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State | WI
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Zip | 53024-9656
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Country | US
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Telephone | 414-464-9777
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Fax | 414-338-5590
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 676-057
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License Number State | WI
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