Individual
DR. LAWRENCE J MANDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2254 MONROE ST, MADISON, WI 53711-1902
(608) 223-9767
Mailing address
S88W25730 EDGEWOOD AVE, MUKWONAGO, WI 53149-9609
(262) 706-3391
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1610-57
WI
103TC0700X
Clinical Psychologist
1610
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1011078
PHYSICIANS PLUS ID NUMBER
WI
05
—
39088600
—
WI
Enumeration date
07/04/2006
Last updated
08/09/2023
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