Provider Demographics
NPI:1609222140
Name:WEBER, MEGAN J
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:J
Last Name:WEBER
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 1:1907 AMERICAN DR
Mailing Address - Street 2:SUITE B2
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1236
Mailing Address - Country:US
Mailing Address - Phone:920-213-1841
Mailing Address - Fax:
Practice Address - Street 1:1907 AMERICAN DR
Practice Address - Street 2:SUITE B2
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-1236
Practice Address - Country:US
Practice Address - Phone:920-213-1841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6080-125101YP2500X
IL180.009717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional