Provider Demographics
NPI:1962141275
Name:KLOTH, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KLOTH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:WI
Mailing Address - Zip Code:53594-1253
Mailing Address - Country:US
Mailing Address - Phone:414-430-7740
Mailing Address - Fax:
Practice Address - Street 1:520 UNIVERSITY AVE STE 320
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4925
Practice Address - Country:US
Practice Address - Phone:608-301-5708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131923121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker