MEDICARE: MIND MATTERS PSYCHOLOGICAL SERVICES, S.C.

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
1	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891516472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND MATTERS PSYCHOLOGICAL SERVICES, S.C.

Provider Business Mailing Address
First Line	:	319 E CLARENCE ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-1503
Country	:	US
Telephone Number	:	414-477-4264
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 W GLEN OAKS LN STE 167
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3317
Country	:	US
Telephone Number	:	414-477-4264
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/PSYCHOLOGIST
Name	:	DR. COLLEEN MARIE DROSDECK
Credential	:	PSYD
Telephone Number	:	414-477-4264

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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