Provider Demographics
NPI:1548279045
Name:VETTER, DOLORES KLUPPEL (PHD)
Entity type:Individual
Prefix:DR
First Name:DOLORES
Middle Name:KLUPPEL
Last Name:VETTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 RUTLAND DUNN TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-2417
Mailing Address - Country:US
Mailing Address - Phone:608-835-8086
Mailing Address - Fax:608-835-0529
Practice Address - Street 1:6401 ODANA RD
Practice Address - Street 2:STE A
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1126
Practice Address - Country:US
Practice Address - Phone:608-204-6076
Practice Address - Fax:608-204-9568
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2400-057103TC0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39138400Medicaid