MEDICARE: KATLYNNE MAGUIRE MSW, APSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	131891	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	131891	OTHER	WI	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205592128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATLYNNE MAGUIRE MSW, APSW

Provider Business Mailing Address
First Line	:	860 HANSEN RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5324
Country	:	US
Telephone Number	:	920-309-6651
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 HANSEN RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5324
Country	:	US
Telephone Number	:	920-309-6651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	11/21/2024

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