Provider Demographics
NPI:1396586806
Name:PATEL, VISHAL ILESH (APSW)
Entity type:Individual
Prefix:
First Name:VISHAL
Middle Name:ILESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 W WILSON ST APT 414
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-5108
Mailing Address - Country:US
Mailing Address - Phone:262-321-9053
Mailing Address - Fax:
Practice Address - Street 1:301 S BLOUNT ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4664
Practice Address - Country:US
Practice Address - Phone:608-405-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134865-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical