Healthcare Provider Details

I. General information

NPI: 1477199602
Provider Name (Legal Business Name): AIMEE METZGER PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 E FOREST ST STE 106
OCONOMOWOC WI
53066-3707
US

IV. Provider business mailing address

405 E FOREST ST STE 106
OCONOMOWOC WI
53066-3707
US

V. Phone/Fax

Practice location:
  • Phone: 262-490-3894
  • Fax:
Mailing address:
  • Phone: 262-804-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AIMEE METZGER
Title or Position: MEMBER/PROVIDER
Credential: LCSW
Phone: 262-804-7729