Provider Demographics
NPI:1285931675
Name:DEAN SANER, PSY.D., LLC
Entity type:Organization
Organization Name:DEAN SANER, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:608-637-2511
Mailing Address - Street 1:122 W SOUTH ST
Mailing Address - Street 2:P.O. BOX 206
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-1943
Mailing Address - Country:US
Mailing Address - Phone:608-637-2511
Mailing Address - Fax:
Practice Address - Street 1:122 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1943
Practice Address - Country:US
Practice Address - Phone:608-637-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2089057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39753300Medicaid
WI39753300Medicaid