Provider Demographics
NPI:1942914890
Name:BROCKMAN, MEGAN B
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:B
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W SEEBOTH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-4329
Mailing Address - Country:US
Mailing Address - Phone:414-378-5379
Mailing Address - Fax:
Practice Address - Street 1:106 W SEEBOTH ST STE 101
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-4329
Practice Address - Country:US
Practice Address - Phone:414-378-5379
Practice Address - Fax:844-295-4043
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9653-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical