Healthcare Provider Details

I. General information

NPI: 1386665651
Provider Name (Legal Business Name): MEGAN HINTZ CADC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 E GENEVA ST
ELKHORN WI
53121-2303
US

IV. Provider business mailing address

285 N JANACEK RD
BROOKFIELD WI
53045-6102
US

V. Phone/Fax

Practice location:
  • Phone: 262-723-1455
  • Fax: 262-723-1556
Mailing address:
  • Phone: 262-641-9050
  • Fax: 262-641-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13898
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: