Healthcare Provider Details

I. General information

NPI: 1164138673
Provider Name (Legal Business Name): JEREMY MEIXNER CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 KESSEL CT
MADISON WI
53711-6233
US

IV. Provider business mailing address

305 S 2ND ST # 2B
WATERTOWN WI
53094-4412
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-2700
  • Fax:
Mailing address:
  • Phone: 920-397-2879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: