Provider Demographics
NPI:1346732872
Name:FORTITUDE PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:FORTITUDE PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:608-381-1125
Mailing Address - Street 1:6314 ODANA RD STE E
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1129
Mailing Address - Country:US
Mailing Address - Phone:608-381-1125
Mailing Address - Fax:
Practice Address - Street 1:6314 ODANA RD STE E
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1129
Practice Address - Country:US
Practice Address - Phone:608-381-1125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2976103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty