Madison Health Psychology Llc | |
700 Rayovac Drive Suite 311 Madison WI 53711-2476 | |
(608) 492-0053 | |
Not Available |
Full Name | Madison Health Psychology Llc |
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Speciality | Psychologist |
Location | 700 Rayovac Drive, Madison, Wisconsin |
Authorized Official Name and Position | Gretchen A Diem (SOLE MEMBER/PSYCHOLOGIST) |
Authorized Official Contact | 6084920053 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Madison Health Psychology Llc 700 Rayovac Drive Suite 311 Madison WI 53711-2476 Ph: (608) 492-0053 | Madison Health Psychology Llc 700 Rayovac Drive Suite 311 Madison WI 53711-2476 Ph: (608) 492-0053 |
NPI Number | 1639759343 |
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Provider Enumeration Date | 04/08/2021 |
Last Update Date | 04/08/2021 |
Certification Date | 04/08/2021 |
Medicare PECOS PAC ID | 8921416165 |
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Medicare Enrollment ID | O20210428000272 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639759343 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103T00000X | Psychologist | (* (Not Available)) | Primary |
Provider Name | Gretchen A Diem |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1972521946 PECOS PAC ID: 0143370478 Enrollment ID: I20090609000130 |
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