Individual
MS. MAEJEANNE FANCHER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
416 W SOUTH ST, OCONOMOWOC, WI 53066-2755
(262) 567-7673
Mailing address
109 PINE TER, OCONOMOWOC, WI 53066-2883
(262) 567-4948
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40938800
—
WI
Enumeration date
10/20/2005
Last updated
07/08/2007
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