| Mequon Clinical Associates, S.c. | |
|
1045 W Glen Oaks Ln Suite 1 Mequon WI 53092-3467 | |
| (262) 241-7778 | |
| Not Available |
| Full Name | Mequon Clinical Associates, S.c. |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1045 W Glen Oaks Ln, Mequon, Wisconsin |
| Authorized Official Name and Position | Jeffrey Taxman (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2622417778 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mequon Clinical Associates, S.c. 1045 W Glen Oaks Ln Suite 1 Mequon WI 53092-3467 Ph: (262) 241-7778 | Mequon Clinical Associates, S.c. 1045 W Glen Oaks Ln Suite 1 Mequon WI 53092-3467 Ph: (262) 241-7778 |
| NPI Number | 1750774766 |
|---|---|
| Provider Enumeration Date | 03/16/2015 |
| Last Update Date | 03/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750774766 | NPI | - | NPPES |
| 2428-226 | Other | WI | CREDENTIAL/LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 2428-226 (Wisconsin) | Primary |
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