Provider Demographics
NPI:1760490205
Name:HASELEU, MINDY ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:ELIZABETH
Last Name:HASELEU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2849
Mailing Address - Country:US
Mailing Address - Phone:608-825-6663
Mailing Address - Fax:608-825-6946
Practice Address - Street 1:705 W MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2849
Practice Address - Country:US
Practice Address - Phone:608-825-6663
Practice Address - Fax:608-825-6946
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2519057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13664OtherDEAN INS
WI39184249622OtherUNITY INSURANCE WATERTOWN
WI39184249623OtherUNITY INS LAKE MILLS
WI2004452OtherPHYSICIANS PLUS INS
WI40976400Medicaid
WI348589OtherMHN INSURANCE