Individual
MARTIN J HAANSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1531 S MADISON ST, APPLETON, WI 54915-1800
(920) 730-4411
Mailing address
1531 S MADISON ST, APPLETON, WI 54915-1800
(920) 730-4411
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
833
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39073500
—
WI
Enumeration date
09/06/2005
Last updated
09/02/2008
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