MEDICARE: COURTNEY JANE MEINDL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	4384-125	WI

General Provider Information

NPI Number	:	1891015327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY JANE MEINDL LPC

Provider Business Mailing Address
First Line	:	620 S 76TH ST
Second Line	:	SUITE 120
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1549
Country	:	US
Telephone Number	:	414-453-1400
Fax Number	:	414-453-2538

Provider Business Practice Location Address
First Line	:	620 S 76TH ST
Second Line	:	SUITE 120
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1549
Country	:	US
Telephone Number	:	414-453-1400
Fax Number	:	414-453-2538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	09/26/2012

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Directions to “ COURTNEY JANE MEINDL LPC” Practice Location

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