Organization
CHAMELEON GROUP
Active
Other names
Wisconsin Young Autism Project
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LAUREE SCHUTT-CHARDON (DIRECTOR OF BILLING)
(608) 288-9040
Entity
Organization
Contact information
Practice address
6402 ODANA RD, MADISON, WI 53719-1123
(608) 288-9040
(608) 288-9042
Mailing address
6402 ODANA RD, MADISON, WI 53719-1123
(608) 288-9040
(608) 288-9042
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42223400
—
WI
Enumeration date
04/28/2008
Last updated
04/28/2008
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