Organization Name: | PLOVER PSYCHOLOGICAL CLINIC, LLC |
NPI Number: | 1356489256 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHARON M PALLEN (EXECUTIVE MANAGER) |
Mailing Address: | 2840 Post Rd Plover |
State: | WI US |
Postal Code: | 544673443 |
Phone Number: | 7153475570 |
Fax Number: | 7153475560 |
NPI Enumeration Date: | 02/02/2007 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TP2701X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Group Psychotherapy |
Taxonomy Definition: |