Basic Information
| Provider Information | |||||||||
| NPI: | 1982762670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BESPALEC | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1911 MARYGLADE DR | ||||||||
| Address2: | |||||||||
| City: | GRAFTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530249656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144649777 | ||||||||
| FaxNumber: | 4143385590 | ||||||||
| Practice Location | |||||||||
| Address1: | 9120 W HAMPTON AVE | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532254960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144649777 | ||||||||
| FaxNumber: | 4143585590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 676-057 | WI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.