Healthcare Provider Details

I. General information

NPI: 1093491102
Provider Name (Legal Business Name): MEGAN LEWIS BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 CHIPPEWA MALL DR
CHIPPEWA FALLS WI
54729-5034
US

IV. Provider business mailing address

2620 STEIN BLVD STE B
EAU CLAIRE WI
54701-2674
US

V. Phone/Fax

Practice location:
  • Phone: 715-836-0064
  • Fax: 715-836-0065
Mailing address:
  • Phone: 715-836-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8239-226
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: