Provider Demographics
NPI:1316766082
Name:SUN PRAIRIE PSYCHOLOGICAL LLC
Entity type:Organization
Organization Name:SUN PRAIRIE PSYCHOLOGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HASELEU
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:920-988-4520
Mailing Address - Street 1:750 WINDSOR ST STE 208
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2149
Mailing Address - Country:US
Mailing Address - Phone:608-825-6663
Mailing Address - Fax:608-825-6946
Practice Address - Street 1:750 WINDSOR ST STE 208
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2149
Practice Address - Country:US
Practice Address - Phone:608-825-6663
Practice Address - Fax:608-825-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty