Provider Demographics
NPI:1760611396
Name:T.S. ALTEPETER, PH.D. SC
Entity Type:Organization
Organization Name:T.S. ALTEPETER, PH.D. SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALTEPETER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-385-7273
Mailing Address - Street 1:1936 ALGOMA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2104
Mailing Address - Country:US
Mailing Address - Phone:920-385-7273
Mailing Address - Fax:920-385-0140
Practice Address - Street 1:1936 ALGOMA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2104
Practice Address - Country:US
Practice Address - Phone:920-385-7273
Practice Address - Fax:920-385-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1320-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39085000Medicaid