MEDICARE: MEAGHAN IANDOLO

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	101YP2500X	Professional Counselor	C.1600053	OH

General Provider Information

NPI Number	:	1417314956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGHAN IANDOLO

Provider Business Mailing Address
First Line	:	4070 STONEHAVEN RD
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-1761
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 KETTERING BLVD
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-2015
Country	:	US
Telephone Number	:	201-259-2542
Fax Number	:

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

Provider Enumeration Date	:	01/27/2016
Last Update Date	:	01/27/2016

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Directions to “ MEAGHAN IANDOLO ” Practice Location

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