=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952553752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. MEAGHEN A PAGEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2008
-----------------------------------------------------
Last Update Date | 03/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37799 PROFESSIONAL CENTER DR SUITE 106
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48154-1153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-343-4695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32451 ANITA DR
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48185-1510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-525-4193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801087027
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------