Provider Demographics
NPI:1235481425
Name:REGAN, MARLENE ANN (MS LPC, NCC, SAS)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:ANN
Last Name:REGAN
Suffix:
Gender:F
Credentials:MS LPC, NCC, SAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7190 SPRING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SOBIESKI
Mailing Address - State:WI
Mailing Address - Zip Code:54171-8600
Mailing Address - Country:US
Mailing Address - Phone:920-366-9734
Mailing Address - Fax:
Practice Address - Street 1:1537 PARK PL STE 600
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1987
Practice Address - Country:US
Practice Address - Phone:920-544-5294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI491-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional