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General NPI Number Information
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NPI Number | 1316820285
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Entity Type | Individual
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Provider Name | MEGAN STASIAK
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Gender | Female
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 2002 SUDDERTH DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6119
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Country | US
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Telephone | 575-257-2368
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Fax |
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Provider Business Mailing Address
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Address Line | UNIT 7600 BOX 267
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City | DPO
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State | AE
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Zip | 09710-0267
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Country | US
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Telephone |
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 402668
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License Number State | NM
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