Provider Demographics
NPI:1548542236
Name:COLE, MEGHAN RENEE (LPC, CSAC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:RENEE
Last Name:COLE
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:RENEE
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CSAC
Mailing Address - Street 1:1020 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-6138
Mailing Address - Country:US
Mailing Address - Phone:920-923-9054
Mailing Address - Fax:920-322-9193
Practice Address - Street 1:1020 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-6138
Practice Address - Country:US
Practice Address - Phone:920-923-9054
Practice Address - Fax:920-322-9193
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15578-132101YA0400X
WI4527-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)