Healthcare Provider Details

I. General information

NPI: 1609488634
Provider Name (Legal Business Name): MEGAN WRENN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COUNTY ROAD I
HUDSON WI
54016-6916
US

IV. Provider business mailing address

1211 COUNTY ROAD I
HUDSON WI
54016-6916
US

V. Phone/Fax

Practice location:
  • Phone: 630-606-1507
  • Fax:
Mailing address:
  • Phone: 630-606-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.022351
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: