Provider Demographics
NPI:1861514630
Name:HECKER, MARGO JOAN (LMFT)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:JOAN
Last Name:HECKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARGO
Other - Middle Name:HECKER
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1417 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2920
Mailing Address - Country:US
Mailing Address - Phone:715-235-1542
Mailing Address - Fax:
Practice Address - Street 1:2925 MONDOVI RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6141
Practice Address - Country:US
Practice Address - Phone:715-832-0238
Practice Address - Fax:715-832-0771
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI735-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43598800Medicaid
WI735-124OtherLMFT LICENSE NUMBER