Healthcare Provider Details

I. General information

NPI: 1366859969
Provider Name (Legal Business Name): MEAGAN IWASKIEWICZ CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 10TH ST
WILMINGTON DE
19801-1422
US

IV. Provider business mailing address

164 DOGWOOD DR
MAGNOLIA DE
19962-1602
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-9360
  • Fax:
Mailing address:
  • Phone: 302-242-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1227
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: