Provider Demographics
NPI:1083810634
Name:METZ, MARILYN ANN (MSW)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:ANN
Last Name:METZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 W ENGLISH MEADOWS DR
Mailing Address - Street 2:J203
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-5405
Mailing Address - Country:US
Mailing Address - Phone:414-727-0955
Mailing Address - Fax:
Practice Address - Street 1:3953 N 76TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-3059
Practice Address - Country:US
Practice Address - Phone:414-616-2292
Practice Address - Fax:414-616-2296
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI109-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39274900Medicaid