Provider Demographics
NPI:1891516472
Name:MIND MATTERS PSYCHOLOGICAL SERVICES, S.C.
Entity type:Organization
Organization Name:MIND MATTERS PSYCHOLOGICAL SERVICES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DROSDECK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:414-477-4264
Mailing Address - Street 1:319 E CLARENCE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1503
Mailing Address - Country:US
Mailing Address - Phone:414-477-4264
Mailing Address - Fax:
Practice Address - Street 1:1017 W GLEN OAKS LN STE 167
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3317
Practice Address - Country:US
Practice Address - Phone:414-477-4264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801027826Medicaid
WI1154550754Medicaid