Healthcare Provider Details

I. General information

NPI: 1134587603
Provider Name (Legal Business Name): MEGAN FERGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN FERGE MSW, LICSW

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 NICOLLET AVE S
BLOOMINGTON MN
55420
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-541-2800
  • Fax: 952-886-7015
Mailing address:
  • Phone: 952-541-2800
  • Fax: 952-886-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22511
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: