Provider Demographics
NPI:1174601389
Name:DENNISON, MARGARET A (PHD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:A
Last Name:DENNISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:A
Other - Last Name:DENNISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-0193
Mailing Address - Country:US
Mailing Address - Phone:608-847-7924
Mailing Address - Fax:
Practice Address - Street 1:102 W STATE ST
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1354
Practice Address - Country:US
Practice Address - Phone:608-847-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1555-125101YP2500X
WI2394-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39771600Medicaid
WI39771600Medicaid