Healthcare Provider Details

I. General information

NPI: 1609115922
Provider Name (Legal Business Name): MEGHAN WALLS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 JESSUP ST
WILMINGTON DE
19802-4210
US

IV. Provider business mailing address

PO BOX 191
WILMINGTON DE
19899-0191
US

V. Phone/Fax

Practice location:
  • Phone: 302-576-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: