Provider Demographics
NPI:1184017527
Name:VANDERGRIFF, MEGHAN (BS)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:VANDERGRIFF
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1487
Mailing Address - Country:US
Mailing Address - Phone:870-892-0027
Mailing Address - Fax:870-892-7945
Practice Address - Street 1:410 CAMP RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1487
Practice Address - Country:US
Practice Address - Phone:870-892-0027
Practice Address - Fax:870-892-7945
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist