Individual
REGAN R EBERHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-2300
Mailing address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-2300
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
RC00056209
WA
104100000X
Social Worker
8795
WI
104100000X
Social Worker
LW60167698
WA
1041C0700X
Clinical Social Worker
Primary
8795
WI
1041C0700X
Clinical Social Worker
LW60167698
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2017451
—
WA
Enumeration date
01/24/2007
Last updated
11/15/2017
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