Healthcare Provider Details

I. General information

NPI: 1841992393
Provider Name (Legal Business Name): MEGAN OLSEN BIRD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 E CLARK ST STE 210
POCATELLO ID
83201-3357
US

IV. Provider business mailing address

1777 E CLARK ST STE 210
POCATELLO ID
83201-3357
US

V. Phone/Fax

Practice location:
  • Phone: 208-203-2088
  • Fax:
Mailing address:
  • Phone: 208-203-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9181119
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: