Provider Demographics
NPI:1962574665
Name:BEHREND, JEANNE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:MARIE
Last Name:BEHREND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 SCHUSTER ROAD
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2437
Mailing Address - Country:US
Mailing Address - Phone:608-837-9700
Mailing Address - Fax:
Practice Address - Street 1:5610 MEDICAL CIRCLE
Practice Address - Street 2:SUITE 25
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1295
Practice Address - Country:US
Practice Address - Phone:608-274-5871
Practice Address - Fax:608-274-5764
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1113057103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
50639OtherNATIONAL REGISTER OF HEAL
WI39034400Medicaid
WI39034400Medicaid