Basic Information
| Provider Information | |||||||||
| NPI: | 1316541600 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LU | ||||||||
| FirstName: | ISAAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 N MIDVALE BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537053265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082389991 | ||||||||
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| Practice Location | |||||||||
| Address1: | 310 N MIDVALE BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537053265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082389991 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2020 | ||||||||
| LastUpdateDate: | 11/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.