Provider Demographics
NPI:1982715751
Name:IRGANG, ALAN (LCSW)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:IRGANG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 YELLOWSTONE CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4209
Mailing Address - Country:US
Mailing Address - Phone:608-203-8126
Mailing Address - Fax:
Practice Address - Street 1:6 YELLOWSTONE CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4209
Practice Address - Country:US
Practice Address - Phone:608-203-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0080001041C0700X
WI7695-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
539580Medicare ID - Type Unspecified