Provider Demographics
NPI:1790974467
Name:DAUN, MARITA L (LCP)
Entity Type:Individual
Prefix:MS
First Name:MARITA
Middle Name:L
Last Name:DAUN
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:MS
Other - First Name:MARITA
Other - Middle Name:L
Other - Last Name:MECCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6510 GRAND TETON PLZ
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1029
Mailing Address - Country:US
Mailing Address - Phone:608-833-9290
Mailing Address - Fax:608-833-9691
Practice Address - Street 1:6510 GRAND TETON PLZ
Practice Address - Street 2:SUITE 406
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1029
Practice Address - Country:US
Practice Address - Phone:608-833-9290
Practice Address - Fax:608-833-9691
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3341-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI001784027OtherMEDICARE
WI43728800Medicaid