Provider Demographics
NPI:1417014945
Name:REGNER, MEG ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEG
Middle Name:ANN
Last Name:REGNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:ANN
Other - Last Name:REGNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:12760 W NORTH AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4628
Mailing Address - Country:US
Mailing Address - Phone:262-439-5500
Mailing Address - Fax:866-439-5221
Practice Address - Street 1:12760 W NORTH AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4628
Practice Address - Country:US
Practice Address - Phone:262-439-5500
Practice Address - Fax:866-439-5221
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1773057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001997Medicare ID - Type Unspecified