Healthcare Provider Details

I. General information

NPI: 1093624280
Provider Name (Legal Business Name): MEGAN SAMANTHA WITTENBERG PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 EDINA INDUSTRIAL BLVD STE 550
EDINA MN
55439-3050
US

IV. Provider business mailing address

5151 EDINA INDUSTRIAL BLVD STE 550
EDINA MN
55439-3050
US

V. Phone/Fax

Practice location:
  • Phone: 651-505-3273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number41371
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: