Provider Demographics
NPI:1982063897
Name:CDL PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:CDL PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:715-497-7230
Mailing Address - Street 1:410 JOHNSON PKWY
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54015-9678
Mailing Address - Country:US
Mailing Address - Phone:715-497-7230
Mailing Address - Fax:715-600-9023
Practice Address - Street 1:410 JOHNSON PKWY
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:WI
Practice Address - Zip Code:54015-9678
Practice Address - Country:US
Practice Address - Phone:715-497-7230
Practice Address - Fax:715-600-9041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3349-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty