Provider Demographics
NPI:1417325978
Name:MEAGHER, PETER JOHN (MSSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:MEAGHER
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 CONEY WESTON PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1003
Mailing Address - Country:US
Mailing Address - Phone:608-234-2778
Mailing Address - Fax:
Practice Address - Street 1:5301 CONEY WESTON PL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1003
Practice Address - Country:US
Practice Address - Phone:608-234-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6675-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39789200Medicaid