Provider Demographics
NPI:1245119007
Name:WILCZEK, MEGAN JEAN (MA, LPC-IT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JEAN
Last Name:WILCZEK
Suffix:
Gender:F
Credentials:MA, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OWEN
Mailing Address - State:WI
Mailing Address - Zip Code:54460-9502
Mailing Address - Country:US
Mailing Address - Phone:715-864-4364
Mailing Address - Fax:
Practice Address - Street 1:3410 OAKWOOD MALL DR STE 700
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2617
Practice Address - Country:US
Practice Address - Phone:715-832-1678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8663-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional