Provider Demographics
NPI:1104293083
Name:BUCKLEY, MEGAN GENE (CSWA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:GENE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 SE ROSE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3942
Mailing Address - Country:US
Mailing Address - Phone:541-900-1506
Mailing Address - Fax:541-900-1507
Practice Address - Street 1:850 SE ROSE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3942
Practice Address - Country:US
Practice Address - Phone:541-900-1506
Practice Address - Fax:541-900-1507
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA54851041C0700X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker