| Elkhart Psychological Services, Llc | |
|
6000 Monona Dr Suite 203 Monona WI 53716-3931 | |
| (608) 223-9767 | |
| (608) 223-9767 |
| Full Name | Elkhart Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 6000 Monona Dr, Monona, Wisconsin |
| Authorized Official Name and Position | Lawrence Mandt (OWNER) |
| Authorized Official Contact | 6082239767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elkhart Psychological Services, Llc 6000 Monona Dr Suite 203 Monona WI 53716-3931 Ph: (608) 223-9767 | Elkhart Psychological Services, Llc 6000 Monona Dr Suite 203 Monona WI 53716-3931 Ph: (608) 223-9767 |
| NPI Number | 1265554430 |
|---|---|
| Provider Enumeration Date | 04/06/2007 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 3375627946 |
|---|---|
| Medicare Enrollment ID | O20080221000351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265554430 | NPI | - | NPPES |
| 1011078 | Other | WI | PHYSICIANS PLUS |
| 39088600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1610 (Wisconsin) | Primary |
| Provider Name | Lawrence J Mandt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255361002 PECOS PAC ID: 3577647148 Enrollment ID: I20080221000337 |
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