Provider Demographics
NPI:1326513862
Name:METZA-PETERSON, LISA MARIE (APSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:METZA-PETERSON
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-1542
Mailing Address - Country:US
Mailing Address - Phone:715-577-9605
Mailing Address - Fax:
Practice Address - Street 1:150 W 1ST ST STE 270
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1770
Practice Address - Country:US
Practice Address - Phone:715-246-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker