Healthcare Provider Details

I. General information

NPI: 1639342934
Provider Name (Legal Business Name): MEGAN A COLLINS LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3593 MEDINA RD # 181
MEDINA OH
44256-8182
US

IV. Provider business mailing address

1051 ARROWHEAD DR
VERMILION OH
44089-3327
US

V. Phone/Fax

Practice location:
  • Phone: 330-536-3746
  • Fax:
Mailing address:
  • Phone: 440-396-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI7153
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: