Provider Demographics
NPI:1952378754
Name:MINDEN, DAVE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVE
Middle Name:
Last Name:MINDEN
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 1:4322 UPLAND DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-5041
Mailing Address - Country:US
Mailing Address - Phone:608-233-0657
Mailing Address - Fax:866-746-7898
Practice Address - Street 1:702 N BLACKHAWK AVE STE 104
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3357
Practice Address - Country:US
Practice Address - Phone:608-233-0657
Practice Address - Fax:866-746-7898
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1812-057103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39105800Medicaid