Healthcare Provider Details

I. General information

NPI: 1164871380
Provider Name (Legal Business Name): MEGAN BEDNARCZYK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN GRASSER

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 S 20TH ST
WAUSAU WI
54403-9343
US

IV. Provider business mailing address

511 S 20TH ST
WAUSAU WI
54403-9343
US

V. Phone/Fax

Practice location:
  • Phone: 715-570-0488
  • Fax:
Mailing address:
  • Phone: 715-570-0488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5073-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: