Healthcare Provider Details

I. General information

NPI: 1487921029
Provider Name (Legal Business Name): MEGAN RENAE GIFFORD CDP, CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29810 SE 472ND ST
ENUMCLAW WA
98022-9302
US

IV. Provider business mailing address

29810 SE 472ND ST
ENUMCLAW WA
98022-9302
US

V. Phone/Fax

Practice location:
  • Phone: 253-332-2501
  • Fax:
Mailing address:
  • Phone: 253-332-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP 00006134
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: