Healthcare Provider Details

I. General information

NPI: 1144719972
Provider Name (Legal Business Name): MRS. MEAGAN LEE PAUMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 17TH AVE NW STE 2
GLENWOOD MN
56334-2159
US

IV. Provider business mailing address

226 DARLING PL
ALEXANDRIA MN
56308-4765
US

V. Phone/Fax

Practice location:
  • Phone: 320-634-3446
  • Fax: 320-634-0384
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: