Individual
TRAVIS JORDAN DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
4621 EASTPARK BLVD, MADISON, WI 53718-2000
(608) 915-0100
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
5290
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/05/2023
Last updated
02/26/2025
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