Basic Information
| Provider Information | |||||||||
| NPI: | 1285931675 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEAN SANER, PSY.D., LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 W SOUTH ST | ||||||||
| Address2: | P.O. BOX 206 | ||||||||
| City: | VIROQUA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546651943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086372511 | ||||||||
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| Address1: | 122 W SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | VIROQUA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546651943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086372511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2011 | ||||||||
| LastUpdateDate: | 02/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | SANER | ||||||||
| AuthorizedOfficialFirstName: | DEAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 6086372511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 2089057 | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 39753300 | 05 | WI | MEDICAID |