MEDICARE: MEGAN A. ELLIOTT LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	10192	KS

General Provider Information

NPI Number	:	1053919787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN A. ELLIOTT LMSW

Provider Business Mailing Address
First Line	:	1713 E WINDWOOD CT
Second Line	:
City	:	DERBY
State	:	KS
Zip	:	67037-3952
Country	:	US
Telephone Number	:	316-871-9206
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N RIDGE RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67212-3323
Country	:	US
Telephone Number	:	316-409-0565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	08/16/2022

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