Healthcare Provider Details

I. General information

NPI: 1245964279
Provider Name (Legal Business Name): JANET MARIE MEEGAN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SAINT ANDREWS CT STE 710
MANKATO MN
56001-8815
US

IV. Provider business mailing address

151 SAINT ANDREWS CT STE 710
MANKATO MN
56001-8815
US

V. Phone/Fax

Practice location:
  • Phone: 507-386-7121
  • Fax: 507-344-0690
Mailing address:
  • Phone: 507-386-7121
  • Fax: 507-344-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29198
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: