Basic Information
| Provider Information | |||||||||
| NPI: | 1811907843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEGROW JR. | ||||||||
| FirstName: | GLEN | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 169 N 9TH AVE | ||||||||
| Address2: | UPPER | ||||||||
| City: | STURGEON BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542351729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207462533 | ||||||||
| FaxNumber: | 9207462439 | ||||||||
| Practice Location | |||||||||
| Address1: | 421 NEBRASKA ST | ||||||||
| Address2: | |||||||||
| City: | STURGEON BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542352249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207462533 | ||||||||
| FaxNumber: | 9207462439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 08/16/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7314-123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YP2500X | 7314-123 | WI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 7314-123 | WI | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | 7314-123 | WI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | 7314-123 | WI | N | Behavioral Health & Social Service Providers | Counselor | 104100000X | 7314-123 | WI | N | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | 7314-123 | WI | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | 071602 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YP2500X | 071602 | NY | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 071602 | NY | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 102L00000X | 071602 | NY | N | Behavioral Health & Social Service Providers | Psychoanalyst | 104100000X | 071602 | NY | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.