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NPI Code Detail

MEDICARE: EATING DISORDER SUPPORT NETWORK

MEDICARE: EATING DISORDER SUPPORT NETWORK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NAOTHERWINA

General Provider Information

NPI Number : 1114599131
Entity Type Code : Organization
Provider Name (Legal Business Name) : EATING DISORDER SUPPORT NETWORK
Provider Business Mailing Address
First Line : 429 GAMMON PL STE 200
Second Line :
City : MADISON
State : WI
Zip : 53719-1053
Country : US
Telephone Number : 608-843-7055
Fax Number : 608-821-0938
Provider Business Practice Location Address
First Line : 429 GAMMON PL STE 200
Second Line :
City : MADISON
State : WI
Zip : 53719-1053
Country : US
Telephone Number : 608-843-7055
Fax Number : 608-821-0938
Authorized Official
Title or Position : OWNER
Name : MELISSA J WALDEN
Credential : MS, LPC
Telephone Number : 608-843-7055
Provider Enumeration Date : 07/12/2021
Last Update Date : 07/12/2021

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Directions to “EATING DISORDER SUPPORT NETWORK ” Practice Location

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