Provider Demographics
NPI:1194414300
Name:SEGEL, MEGAN SUZANNE (BEHAVIORAL TECH)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:SUZANNE
Last Name:SEGEL
Suffix:
Gender:F
Credentials:BEHAVIORAL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 NE 157TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-5209
Mailing Address - Country:US
Mailing Address - Phone:360-949-3677
Mailing Address - Fax:
Practice Address - Street 1:4702 NE 157TH CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-5209
Practice Address - Country:US
Practice Address - Phone:360-949-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician