Provider Demographics
NPI:1700696465
Name:DITTRICH, MEGAN E (APSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:DITTRICH
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:DAUENHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW
Mailing Address - Street 1:176 W TRIPOLI AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3847
Mailing Address - Country:US
Mailing Address - Phone:203-331-2297
Mailing Address - Fax:
Practice Address - Street 1:1245 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9323
Practice Address - Country:US
Practice Address - Phone:203-331-2297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI135098-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical