Provider Demographics
NPI:1215604764
Name:OUELLETTE, MEGAN (BCBA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MESTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1504 10TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4211
Mailing Address - Country:US
Mailing Address - Phone:507-358-2550
Mailing Address - Fax:
Practice Address - Street 1:3501 ALDRICH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4149
Practice Address - Country:US
Practice Address - Phone:612-440-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst