Provider Demographics
NPI:1639225758
Name:POFAHL, MARGARET ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ANN
Last Name:POFAHL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:ANN
Other - Last Name:KLEIN POFAHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:500 ELM GROVE RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122
Mailing Address - Country:US
Mailing Address - Phone:262-782-2090
Mailing Address - Fax:262-782-2092
Practice Address - Street 1:500 ELM GROVE RD
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122
Practice Address - Country:US
Practice Address - Phone:262-782-2090
Practice Address - Fax:262-782-2092
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2031231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39565300Medicaid
WI887450025Medicare UPIN