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General NPI Number Information
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NPI Number | 1780436113
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Entity Type | Individual
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Provider Name | MEREDITH HEAD MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 4200 N HOLTON ST STE 400
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City | MILWAUKEE
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State | WI
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Zip | 53212-1027
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Country | US
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Telephone | 414-964-2565
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Fax |
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Provider Business Mailing Address
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Address Line | 4035 N STOWELL AVE
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City | SHOREWOOD
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State | WI
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Zip | 53211-2133
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Country | US
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Telephone | 414-324-7772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10954-125
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License Number State | WI
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