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Organization
MEQUON CLINICAL ASSOCIATES, S.C.
Active
Organization
MEQUON CLINICAL ASSOCIATES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY TAXMAN M.D. (MEDICAL DIRECTOR)
(262) 241-7778
Entity
Organization
Contact information
Practice address
1045 W GLEN OAKS LN, SUITE 1, MEQUON, WI 53092-3467
(262) 241-7778
Mailing address
1045 W GLEN OAKS LN, SUITE 1, MEQUON, WI 53092-3467
(262) 241-7778
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2428-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2428-226
CREDENTIAL/LICENSE NUMBER
WI
Enumeration date
03/16/2015
Last updated
03/16/2015
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