Provider Demographics
NPI:1497591994
Name:LAKE, MAGGIE (CAPSW)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:LAKE
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:EMILY
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1516 BRAWLEY ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3508
Mailing Address - Country:US
Mailing Address - Phone:715-572-3533
Mailing Address - Fax:
Practice Address - Street 1:1699 SCHOFIELD AVE STE 120
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2332
Practice Address - Country:US
Practice Address - Phone:715-907-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1348851211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical