Provider Demographics
NPI:1215565544
Name:MEEHAN, NATALYA GAIL (LICSW)
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:GAIL
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 3RD ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5815
Mailing Address - Country:US
Mailing Address - Phone:612-469-5111
Mailing Address - Fax:
Practice Address - Street 1:1400 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-3081
Practice Address - Country:US
Practice Address - Phone:507-663-9000
Practice Address - Fax:507-645-2096
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN255111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical