Provider Demographics
NPI:1184211617
Name:COOPER, MEGAN MARIE (CSW-PIP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:COOPER
Suffix:
Gender:F
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S CLEARBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-7821
Mailing Address - Country:US
Mailing Address - Phone:712-898-9139
Mailing Address - Fax:
Practice Address - Street 1:7511 S LOUISE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5997
Practice Address - Country:US
Practice Address - Phone:605-312-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28931104100000X
SD5019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker