Basic Information
| Provider Information | |||||||||
| NPI: | 1154833234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARMON | ||||||||
| FirstName: | SADETTE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC-IT, SAC-IT, | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SPOONER | ||||||||
| OtherFirstName: | SADETTE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5900 MONONA DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MONONA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537163561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082861132 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 49 KESSEL CT | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537116275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082802700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2017 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 18180130 | WI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101Y00000X | 3567226 | WI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.