Healthcare Provider Details

I. General information

NPI: 1104649243
Provider Name (Legal Business Name): MEGGAN KATHLEEN LAZZARONI APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 W MAIN ST STE 700
LAKE GENEVA WI
53147-1997
US

IV. Provider business mailing address

647 W MAIN ST STE 700
LAKE GENEVA WI
53147-1997
US

V. Phone/Fax

Practice location:
  • Phone: 262-729-3143
  • Fax:
Mailing address:
  • Phone: 262-729-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number135593-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: