Provider Demographics
NPI:1669662904
Name:BACH, MARGARET E (MSSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:E
Last Name:BACH
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:E
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2840 POST RD
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-3443
Mailing Address - Country:US
Mailing Address - Phone:715-347-5570
Mailing Address - Fax:715-347-5560
Practice Address - Street 1:2840 POST RD
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-3443
Practice Address - Country:US
Practice Address - Phone:715-347-5570
Practice Address - Fax:715-347-5560
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44215900Medicaid