Healthcare Provider Details

I. General information

NPI: 1639660152
Provider Name (Legal Business Name): MEGHAN CONKLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 SONOMA HWY STE B
SANTA ROSA CA
95409-4165
US

IV. Provider business mailing address

4415 SONOMA HWY STE B
SANTA ROSA CA
95409-4165
US

V. Phone/Fax

Practice location:
  • Phone: 707-327-0909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: