Provider Demographics
NPI:1053657106
Name:HEMMELER WHITTEMORE, MEGAN RENEE (PHD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:RENEE
Last Name:HEMMELER WHITTEMORE
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 CRAIG RD STE 128
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7168
Mailing Address - Country:US
Mailing Address - Phone:636-744-3744
Mailing Address - Fax:
Practice Address - Street 1:655 CRAIG RD STE 128
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7168
Practice Address - Country:US
Practice Address - Phone:636-744-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015013948103TC0700X
WAPY 60348768103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical