Provider Demographics
NPI:1518672294
Name:TIMM, MEGAN (LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:TIMM
Suffix:
Gender:
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 PORLIER ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3432
Mailing Address - Country:US
Mailing Address - Phone:715-304-7033
Mailing Address - Fax:
Practice Address - Street 1:1234 PORLIER ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3432
Practice Address - Country:US
Practice Address - Phone:715-304-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA133091041C0700X
MN311291041C0700X
WI101581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical