Provider Demographics
NPI:1821048943
Name:BELLG, ALBERT JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JOHN
Last Name:BELLG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 S LAWE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-2400
Mailing Address - Country:US
Mailing Address - Phone:920-996-0887
Mailing Address - Fax:920-799-4714
Practice Address - Street 1:1620 S LAWE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-2400
Practice Address - Country:US
Practice Address - Phone:920-996-0887
Practice Address - Fax:920-799-4714
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2382-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39136800Medicaid
WI0022Medicare ID - Type Unspecified
WI39136800Medicaid