Healthcare Provider Details

I. General information

NPI: 1134042070
Provider Name (Legal Business Name): ANDREW JAY MACGREGOR LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 5TH ST W
ASHLAND WI
54806-1423
US

IV. Provider business mailing address

908 8TH ST
BARABOO WI
53913-1720
US

V. Phone/Fax

Practice location:
  • Phone: 715-292-0139
  • Fax:
Mailing address:
  • Phone: 920-245-0460
  • Fax: 920-245-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2874-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: