1578625539 NPI number — MS. JANE MARBURY KEGGI MSW LCSW

Table of content: MS. JANE MARBURY KEGGI MSW LCSW (NPI 1578625539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578625539 NPI number — MS. JANE MARBURY KEGGI MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEGGI
Provider First Name:
JANE
Provider Middle Name:
MARBURY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARBURY
Provider Other First Name:
JANE
Provider Other Middle Name:
MASSIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578625539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 W COLLEGE AVE
Provider Second Line Business Mailing Address:
SUITE 815
Provider Business Mailing Address City Name:
APPLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-733-1992
Provider Business Mailing Address Fax Number:
920-733-1866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 W COLLEGE AVE
Provider Second Line Business Practice Location Address:
SUITE 815
Provider Business Practice Location Address City Name:
APPLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-733-1992
Provider Business Practice Location Address Fax Number:
920-733-1866
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  LCSW 594-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 104100000X , with the licence number: LCSW 594-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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