MEDICARE: DR. DAVE MINDEN PH.D.

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	103TC1900X	Counseling Psychologist	1812-057	WI

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

General Provider Information

NPI Number	:	1952378754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVE MINDEN PH.D.

Provider Business Mailing Address
First Line	:	4322 UPLAND DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-5041
Country	:	US
Telephone Number	:	608-233-0657
Fax Number	:	866-746-7898

Provider Business Practice Location Address
First Line	:	702 N BLACKHAWK AVE STE 104
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-3357
Country	:	US
Telephone Number	:	608-233-0657
Fax Number	:	866-746-7898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	04/15/2014

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Directions to “ DR. DAVE MINDEN PH.D.” Practice Location

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