Provider Demographics
NPI:1740004316
Name:MCKEOWN, MIA BELLE (MSW, APSW)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:BELLE
Last Name:MCKEOWN
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 ALTOONA AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4320
Mailing Address - Country:US
Mailing Address - Phone:815-210-8739
Mailing Address - Fax:
Practice Address - Street 1:3610 OAKWOOD MALL DR STE 104
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-9084
Practice Address - Country:US
Practice Address - Phone:815-210-8739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1352191211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical