Provider Demographics
NPI:1619053857
Name:MESECK, CHUCK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHUCK
Middle Name:
Last Name:MESECK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 N MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2200
Mailing Address - Country:US
Mailing Address - Phone:414-536-8333
Mailing Address - Fax:414-536-8348
Practice Address - Street 1:3800 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2200
Practice Address - Country:US
Practice Address - Phone:414-536-8333
Practice Address - Fax:414-536-8348
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3102125103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40938200Medicaid