Active NPI
Dean Edward Stolldorf, PSYCHOLOGIST
- Psychologist
- Burlington, WI
National Provider Identifier
1194789032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1243057
- Practice address
- 441 Milwaukee Ave Ste 2
Burlington, WI 53105-1230 - Phone
- (262) 767-0440
- Fax
- (262) 767-0777
- NPI assigned
- Apr 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1243057 | WI | Primary |
Addresses
Primary practice location
441 Milwaukee Ave Ste 2
Burlington, WI 53105-1230
Mailing address
441 Milwaukee Ave Ste 2
Burlington, WI 53105-1230
Phone (262) 767-0440
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39071100 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1243057 | WI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288656000000",
"number": "1194789032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "441 MILWAUKEE AVE STE 2",
"city": "BURLINGTON",
"state": "WI",
"postal_code": "531051230",
"telephone_number": "262-767-0440",
"fax_number": "262-767-0777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "441 MILWAUKEE AVE STE 2",
"city": "BURLINGTON",
"state": "WI",
"postal_code": "531051230",
"telephone_number": "262-767-0440",
"fax_number": "262-767-0777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOLLDORF",
"first_name": "DEAN",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-17",
"last_updated": "2010-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "1243057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39071100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.