MEDICARE: LEAH ANN MEYERHOFER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1710503131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH ANN MEYERHOFER

Provider Business Mailing Address
First Line	:	804 KRISTY ST
Second Line	:
City	:	KAUKAUNA
State	:	WI
Zip	:	54130-3848
Country	:	US
Telephone Number	:	920-810-4477
Fax Number	:

Provider Business Practice Location Address
First Line	:	4513 VERNON BLVD
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-4993
Country	:	US
Telephone Number	:	608-236-4460
Fax Number	:	608-236-4461

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

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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