Healthcare Provider Details

I. General information

NPI: 1003408501
Provider Name (Legal Business Name): ANDERSON B MCGREGOR MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 06/13/2025
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 STEWART AVE STE 310
WAUSAU WI
54401-4162
US

IV. Provider business mailing address

2620 STEWART AVE STE 310
WAUSAU WI
54401-4162
US

V. Phone/Fax

Practice location:
  • Phone: 715-848-0525
  • Fax: 715-848-8665
Mailing address:
  • Phone: 715-848-0525
  • Fax: 715-848-8665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10106-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4882-226
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10106-25
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: