Provider Demographics
NPI:1407319130
Name:FISCHER, MEGHAN K
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:K
Last Name:FISCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 MAIN ST APT E
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2489
Mailing Address - Country:US
Mailing Address - Phone:920-915-9615
Mailing Address - Fax:
Practice Address - Street 1:628 MAIN ST APT E
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2489
Practice Address - Country:US
Practice Address - Phone:920-915-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7329-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional