Provider Demographics
NPI:1003408501
Name:MCGREGOR, ANDERSON B (MA, LPC)
Entity type:Individual
Prefix:
First Name:ANDERSON
Middle Name:B
Last Name:MCGREGOR
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 STEWART AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4162
Mailing Address - Country:US
Mailing Address - Phone:715-848-0525
Mailing Address - Fax:715-848-8665
Practice Address - Street 1:2620 STEWART AVE STE 310
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4162
Practice Address - Country:US
Practice Address - Phone:715-848-0525
Practice Address - Fax:715-848-8665
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4882-226104100000X
WI10106-25104100000X
WI10106-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4882-226OtherSTATE LICENSE