MEDICARE: MAEGAN RAE HARDING

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	103K00000X	Behavior Analyst	F8090726	CA

General Provider Information

NPI Number	:	1104323674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAEGAN RAE HARDING

Provider Business Mailing Address
First Line	:	21600 OXNARD ST STE 1800
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7807
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:	--

Provider Business Practice Location Address
First Line	:	161 BUTCHER RD STE B
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95687-5685
Country	:	US
Telephone Number	:	707-305-1118
Fax Number	:

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

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	04/10/2018

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