Healthcare Provider Details

I. General information

NPI: 1245140151
Provider Name (Legal Business Name): MEGAN STEPHANIE MONTROSE SANDIFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BRIDGE ST
WALLA WALLA WA
99362-3570
US

IV. Provider business mailing address

PO BOX 1075
WALLA WALLA WA
99362-0021
US

V. Phone/Fax

Practice location:
  • Phone: 509-527-3050
  • Fax:
Mailing address:
  • Phone: 509-529-1692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number70148471
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: