| Sun Prairie Psychological Services | |
|
705 W Main St Suite 3 Sun Prairie WI 53590-2849 | |
| (608) 825-6663 | |
| (608) 825-6946 |
| Full Name | Sun Prairie Psychological Services |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 705 W Main St, Sun Prairie, Wisconsin |
| Authorized Official Name and Position | Lawrence James Stava (PARTNER) |
| Authorized Official Contact | 6088256663 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sun Prairie Psychological Services 705 W Main St Suite 3 Sun Prairie WI 53590-2849 Ph: (608) 825-6663 | Sun Prairie Psychological Services 705 W Main St Suite 3 Sun Prairie WI 53590-2849 Ph: (608) 825-6663 |
| NPI Number | 1306991682 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306991682 | NPI | - | NPPES |
| 42168100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1891 (Wisconsin) | Primary |
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