Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2011-57 | WI |
Y | 103T00000X | Psychologist | 2011-57 | WI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2011-57 | WI |
N | 103TH0100X | Health Service | 2011-57 | WI |
NPI | 1316963994 |
---|---|
Provider Name | Stephen Charles Billingham |
First Address | Madison, WI 53705-3250 |
Second Address | Madison, WI 53705-3250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 18/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39135700 | (05) | WI |
P65525 | (02) | WI |