Basic Information
| Provider Information | |||||||||
| NPI: | 1457683252 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MESICH | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | OLIVIA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.P.C., C.R.C., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2026 JENIFER ST | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537045527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082836315 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6502 GRAND TETON PLZ | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537191047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088277220 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2010 | ||||||||
| LastUpdateDate: | 02/03/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4134125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.