# PSYCHOLOGY CLINIC INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336222769
- **Authorized official:** DR. DAVID ROETHE PH.D. (PSYCHOLOGIST/CO-DIRECTOR)
- **Authorized official phone:** (608) 280-6486

## Contact information

- **Practice address:** 702 N BLACKHAWK AVE STE 212, MADISON, WI 53705-3357
- **Practice address phone:** (608) 238-9991
- **Practice address fax:** (608) 238-1929
- **Mailing address:** 702 N BLACKHAWK AVE STE 212, MADISON, WI 53705-3357
- **Mailing address phone:** (608) 238-9991
- **Mailing address fax:** (608) 238-1929

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 1919 | WI | Yes |

## Other

- **Enumeration date:** 10/21/2006
- **Last updated:** 03/05/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 42161100 | — | WI |