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General NPI Number Information
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NPI Number | 1003554528
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Entity Type | Individual
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Provider Name | MEREDITH MARGARET SHOCKLEY
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Gender | Female
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1720 10TH AVE. S SUITE 4-150
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City | GREAT FALLS
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State | MONTANA
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Zip | 59405
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Country | UM
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Telephone | 480-361-1025
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Fax | 480-814-7488
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Provider Business Mailing Address
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Address Line | 18521 E QUEEN CREEK RD STE 105-627
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-5870
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Country | US
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Telephone | 480-361-1025
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Fax | 480-814-7488
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-217169
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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