Healthcare Provider Details

I. General information

NPI: 1235040627
Provider Name (Legal Business Name): MEGAN RANDOLPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 HORACE ST
TOLEDO OH
43606-4859
US

IV. Provider business mailing address

1075 HORACE ST
TOLEDO OH
43606-4859
US

V. Phone/Fax

Practice location:
  • Phone: 419-671-4200
  • Fax: 419-671-4260
Mailing address:
  • Phone: 419-671-4200
  • Fax: 419-671-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.02573
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: