Individual
SAMANTHA MARIE MITTLESTADT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPS
Contact information
Practice address
116 W WASHINGTON AVE, MADISON, WI 53703-2740
(608) 251-6901
(608) 251-1549
Mailing address
116 W WASHINGTON AVE, MADISON, WI 53703-2740
(608) 251-6901
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
171M00000X
WI
Other
Enumeration date
07/31/2024
Last updated
07/31/2024
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