Healthcare Provider Details

I. General information

NPI: 1457683252
Provider Name (Legal Business Name): ANNE OLIVIA MESICH L.P.C., C.R.C., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 ATWOOD AVE STE 203
MADISON WI
53704-5384
US

IV. Provider business mailing address

2026 JENIFER ST
MADISON WI
53704-5527
US

V. Phone/Fax

Practice location:
  • Phone: 608-556-0752
  • Fax:
Mailing address:
  • Phone: 608-283-6315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1254134
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4134125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: