Healthcare Provider Details

I. General information

NPI: 1619199643
Provider Name (Legal Business Name): MEGHAN W ANDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGHAM G WOOLLEY LCSW

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N. HWY 414
MOUNTAIN VIEW WY
82939
US

IV. Provider business mailing address

821 SAGE AVE.
KEMMERER WY
83101-3113
US

V. Phone/Fax

Practice location:
  • Phone: 307-782-3097
  • Fax: 307-782-3077
Mailing address:
  • Phone: 307-877-4466
  • Fax: 307-877-9832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-27764
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-797
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: