Healthcare Provider Details

I. General information

NPI: 1609172956
Provider Name (Legal Business Name): MEGAN OLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 SOUTH 6TH STREET
COTTAGE GROVE OR
97424
US

IV. Provider business mailing address

PO BOX 5
COTTAGE GROVE OR
97424-0001
US

V. Phone/Fax

Practice location:
  • Phone: 541-767-4086
  • Fax: 541-942-9712
Mailing address:
  • Phone: 541-942-3939
  • Fax: 541-942-9310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7005
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: