Provider Demographics
NPI:1700121043
Name:BITTERMANN, MEGAN ALYSSA (MA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALYSSA
Last Name:BITTERMANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ALYSSA
Other - Last Name:JELEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1601 30TH ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 5TH AVE S
Practice Address - Street 2:#414
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-9200
Practice Address - Country:US
Practice Address - Phone:608-784-9645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI294-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist