Provider Demographics
NPI:1851946040
Name:MARTENS, MEGAN (LPC, SAC-IT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MARTENS
Suffix:
Gender:F
Credentials:LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 N IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5328
Mailing Address - Country:US
Mailing Address - Phone:920-265-3715
Mailing Address - Fax:
Practice Address - Street 1:5241 N IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-5328
Practice Address - Country:US
Practice Address - Phone:920-265-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18686-130101YA0400X
WI4596226101YP2500X
WI8456-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty