Provider Demographics
NPI:1114737368
Name:LUKKONEN, MEGAN COLLEEN TAPLIN (LEP, BCBA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:COLLEEN TAPLIN
Last Name:LUKKONEN
Suffix:
Gender:F
Credentials:LEP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 SOMBRERO CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9062
Mailing Address - Country:US
Mailing Address - Phone:530-401-4544
Mailing Address - Fax:
Practice Address - Street 1:380 CROWN POINT CIR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9089
Practice Address - Country:US
Practice Address - Phone:530-478-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABAC229649103K00000X
CALEP3683103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst