Provider Demographics
NPI:1073674842
Name:MEIDENBAUER, JEAN M (MS LPC)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:M
Last Name:MEIDENBAUER
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:MEISTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:635 MUELLER ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027
Mailing Address - Country:US
Mailing Address - Phone:262-224-7006
Mailing Address - Fax:262-397-8023
Practice Address - Street 1:635 MUELLER ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027
Practice Address - Country:US
Practice Address - Phone:262-224-7006
Practice Address - Fax:262-397-8023
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3716125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43703000Medicaid