| 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 |
| Location | 705 W Main St, Sun Prairie, Wisconsin |
| Authorized Official Name and Position | Lawrence James Stava (PARTNER) |
| Authorized Official Contact | 6088256663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| 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 |
| Medicare PECOS PAC ID | 7416909205 |
|---|---|
| Medicare Enrollment ID | O20050221000503 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306991682 | NPI | - | NPPES |
| 42168100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1891 (Wisconsin) | Primary |
| Provider Name | Mindy E Haseleu |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760490205 PECOS PAC ID: 0840393419 Enrollment ID: I20070320000344 |
| Provider Name | Mary E Mikalson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790841179 PECOS PAC ID: 1951580513 Enrollment ID: I20110127001160 |
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