Provider Demographics
NPI:1992855134
Name:CLUNE, CONSTANCE S (PHD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:S
Last Name:CLUNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1202
Mailing Address - Country:US
Mailing Address - Phone:608-274-4273
Mailing Address - Fax:608-274-5546
Practice Address - Street 1:5534 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1202
Practice Address - Country:US
Practice Address - Phone:608-274-4273
Practice Address - Fax:608-274-5546
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI494-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39065500Medicaid