Provider Demographics
NPI:1578625539
Name:KEGGI, JANE MARBURY (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:MARBURY
Last Name:KEGGI
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:MASSIE
Other - Last Name:MARBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 W COLLEGE AVE
Mailing Address - Street 2:SUITE 815
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911
Mailing Address - Country:US
Mailing Address - Phone:920-733-1992
Mailing Address - Fax:920-733-1866
Practice Address - Street 1:103 W COLLEGE AVE
Practice Address - Street 2:SUITE 815
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911
Practice Address - Country:US
Practice Address - Phone:920-733-1992
Practice Address - Fax:920-733-1866
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WILCSW 594-123103T00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker