Provider Demographics
NPI:1225716970
Name:MANSAVAGE, MEGAN (MSW, LICSW, LADC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MANSAVAGE
Suffix:
Gender:F
Credentials:MSW, LICSW, LADC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:KREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45568 US 71
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:MN
Mailing Address - Zip Code:56461
Mailing Address - Country:US
Mailing Address - Phone:651-408-2574
Mailing Address - Fax:
Practice Address - Street 1:1741 15TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-8755
Practice Address - Country:US
Practice Address - Phone:218-751-6553
Practice Address - Fax:218-751-1846
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN243181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical