| Psychology Clinic Inc. | |
|
310 N Midvale Blvd Ste 202 Madison WI 53705-3265 | |
| (608) 852-8585 | |
| (608) 238-1929 |
| Full Name | Psychology Clinic Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 310 N Midvale Blvd Ste 202, Madison, Wisconsin |
| Authorized Official Name and Position | David Roethe (PSYCHOLOGIST/CO-DIRECTOR) |
| Authorized Official Contact | 6082806486 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychology Clinic Inc. 310 N Midvale Blvd Ste 202 Madison WI 53705-3265 Ph: (608) 852-8585 | Psychology Clinic Inc. 310 N Midvale Blvd Ste 202 Madison WI 53705-3265 Ph: (608) 852-8585 |
| NPI Number | 1336222769 |
|---|---|
| Provider Enumeration Date | 10/21/2006 |
| Last Update Date | 10/25/2010 |
| Medicare PECOS PAC ID | 0143216747 |
|---|---|
| Medicare Enrollment ID | O20040421000182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336222769 | NPI | - | NPPES |
| 42161100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1919 (Wisconsin) | Primary |
| Provider Name | Kerri M Lehman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184665291 PECOS PAC ID: 6406842459 Enrollment ID: I20040423000813 |
| Provider Name | Michael T Witkovsky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629044797 PECOS PAC ID: 0749236990 Enrollment ID: I20050330000810 |
| Provider Name | Brett V Brasher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952518839 PECOS PAC ID: 9335277896 Enrollment ID: I20100505000045 |
| Provider Name | Jane A Woods |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508089319 PECOS PAC ID: 9537343769 Enrollment ID: I20110412000536 |
| Provider Name | David J Roethe |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548338239 PECOS PAC ID: 9133119944 Enrollment ID: I20111201000635 |
| Provider Name | Andrea Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1265705842 PECOS PAC ID: 8820252646 Enrollment ID: I20120607000255 |
| Provider Name | Erin C Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649503368 PECOS PAC ID: 0446530992 Enrollment ID: I20161129002572 |
| Provider Name | Jordyn S Czerwinski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215318688 PECOS PAC ID: 4789914565 Enrollment ID: I20190920000653 |
| Provider Name | Shannon Lynn Patterson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871079848 PECOS PAC ID: 9436586864 Enrollment ID: I20200225002173 |
| Provider Name | Lori E King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902431380 PECOS PAC ID: 0345658910 Enrollment ID: I20210420001443 |
| Provider Name | Greg T Dezell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699368050 PECOS PAC ID: 0749699791 Enrollment ID: I20210504002579 |
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