Healthcare Provider Details

I. General information

NPI: 1508216037
Provider Name (Legal Business Name): MRS. MEGAN M SHICKLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7418 POTTER RD
FLUSHING MI
48433-9454
US

IV. Provider business mailing address

7418 POTTER RD
FLUSHING MI
48433-9454
US

V. Phone/Fax

Practice location:
  • Phone: 810-444-2977
  • Fax:
Mailing address:
  • Phone: 810-444-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001043
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: