Provider Demographics
NPI:1750116877
Name:BAKKUM, MEAGHAN ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:ELIZABETH
Last Name:BAKKUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:ELIZABETH
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1005 BURRIE LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5545
Mailing Address - Country:US
Mailing Address - Phone:262-385-7336
Mailing Address - Fax:
Practice Address - Street 1:N17W24222 RIVERWOOD DR STE 170
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1134
Practice Address - Country:US
Practice Address - Phone:262-330-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9850-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical