Provider Demographics
NPI:1669860060
Name:WOLF, MEGAN LYNN (SAC, LPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:WOLF
Suffix:
Gender:
Credentials:SAC, LPC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LYNN
Other - Last Name:SCHWAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAC, LPC
Mailing Address - Street 1:121 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:SHULLSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53586
Mailing Address - Country:US
Mailing Address - Phone:608-379-3338
Mailing Address - Fax:608-319-4579
Practice Address - Street 1:121 W WATER ST
Practice Address - Street 2:
Practice Address - City:SHULLSBURG
Practice Address - State:WI
Practice Address - Zip Code:53586
Practice Address - Country:US
Practice Address - Phone:608-379-3338
Practice Address - Fax:608-319-4579
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16121-131101YA0400X
WI7061-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI54510Medicaid