Provider Demographics
NPI:1508546276
Name:GRIEBENOW, MEGAN BETH (MSW, APSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BETH
Last Name:GRIEBENOW
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:BETH
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1791 COUNTY HIGHWAY OO
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5347
Mailing Address - Country:US
Mailing Address - Phone:715-797-2770
Mailing Address - Fax:
Practice Address - Street 1:1791 COUNTY HIGHWAY OO
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5347
Practice Address - Country:US
Practice Address - Phone:715-797-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134368-121104100000X
WI1343681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker