Healthcare Provider Details

I. General information

NPI: 1003554528
Provider Name (Legal Business Name): MEREDITH MARGARET SHOCKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 10TH AVE. S SUITE 4-150
GREAT FALLS MONTANA
59405
UM

IV. Provider business mailing address

18521 E QUEEN CREEK RD STE 105-627
QUEEN CREEK AZ
85142-5870
US

V. Phone/Fax

Practice location:
  • Phone: 480-361-1025
  • Fax: 480-814-7488
Mailing address:
  • Phone: 480-361-1025
  • Fax: 480-814-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-217169
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: