Healthcare Provider Details

I. General information

NPI: 1114737368
Provider Name (Legal Business Name): MEGAN COLLEEN TAPLIN LUKKONEN LEP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CROWN POINT CIR
GRASS VALLEY CA
95945-9089
US

IV. Provider business mailing address

2220 SOMBRERO CT
AUBURN CA
95603-9062
US

V. Phone/Fax

Practice location:
  • Phone: 530-478-6400
  • Fax:
Mailing address:
  • Phone: 530-401-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP3683
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBAC229649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: