Healthcare Provider Details

I. General information

NPI: 1245717743
Provider Name (Legal Business Name): MEGAN THERESA CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S 21ST ST FL 4
SAINT LOUIS MO
63103-2272
US

IV. Provider business mailing address

4082 TOENGES AVE
SAINT LOUIS MO
63116-2840
US

V. Phone/Fax

Practice location:
  • Phone: 314-436-1177
  • Fax:
Mailing address:
  • Phone: 314-698-1989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: