MEDICARE: MS. MAEGAN KAYLA WONG

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	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1710468913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAEGAN KAYLA WONG

Provider Business Mailing Address
First Line	:	3223 E FLAMINGO RD APT 207
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 E FLAMINGO RD APT 207
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4332
Country	:	US
Telephone Number	:	808-346-3893
Fax Number	:

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

Provider Enumeration Date	:	08/24/2018
Last Update Date	:	08/24/2018

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