Provider Demographics
NPI:1699241406
Name:SEDLACEK, MEGAN (RBT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SEDLACEK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RYAN PL
Mailing Address - Street 2:
Mailing Address - City:KIEFER
Mailing Address - State:OK
Mailing Address - Zip Code:74041-4558
Mailing Address - Country:US
Mailing Address - Phone:918-697-9564
Mailing Address - Fax:
Practice Address - Street 1:3501 W KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8948
Practice Address - Country:US
Practice Address - Phone:918-994-2764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator