Provider Demographics
NPI:1982762670
Name:BESPALEC, DALE ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:ANTHONY
Last Name:BESPALEC
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 1:1911 MARYGLADE DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9656
Mailing Address - Country:US
Mailing Address - Phone:414-464-9777
Mailing Address - Fax:414-338-5590
Practice Address - Street 1:9120 W HAMPTON AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4960
Practice Address - Country:US
Practice Address - Phone:414-464-9777
Practice Address - Fax:414-358-5590
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI676-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist