Provider Demographics
NPI:1225791478
Name:HENDRICKS, MEGHAN RUTH
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:RUTH
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 TOPAZ LN
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-4056
Mailing Address - Country:US
Mailing Address - Phone:304-279-5799
Mailing Address - Fax:
Practice Address - Street 1:144 TOPAZ LN
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-4056
Practice Address - Country:US
Practice Address - Phone:304-279-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002010103K00000X
CT1223103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst