Provider Demographics
NPI:1932146883
Name:STADLER, DEANNA DAHLEN III
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:DAHLEN
Last Name:STADLER
Suffix:III
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 SCHROEDER RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2401
Mailing Address - Country:US
Mailing Address - Phone:608-441-0123
Mailing Address - Fax:608-441-0126
Practice Address - Street 1:6506 SCHROEDER RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2401
Practice Address - Country:US
Practice Address - Phone:608-441-0123
Practice Address - Fax:608-441-0126
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI702-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40947000Medicaid
WI702-124OtherLICENSE