Healthcare Provider Details

I. General information

NPI: 1306369202
Provider Name (Legal Business Name): MEGAN HAUG APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2017
Last Update Date: 07/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 W LINCOLN AVE STE 106
MILWAUKEE WI
53227-2136
US

IV. Provider business mailing address

1039 W MASON ST
GREEN BAY WI
54303-1842
US

V. Phone/Fax

Practice location:
  • Phone: 414-541-5100
  • Fax:
Mailing address:
  • Phone: 920-965-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130722
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: