Provider Demographics
NPI:1053950592
Name:MYREN, EMMA PHILLIPS (APSW)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:PHILLIPS
Last Name:MYREN
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:KATHLEEN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2824
Mailing Address - Country:US
Mailing Address - Phone:608-215-6227
Mailing Address - Fax:
Practice Address - Street 1:710 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2824
Practice Address - Country:US
Practice Address - Phone:608-389-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490244701041C0700X
WI97651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical