Provider Demographics
NPI:1295184356
Name:DIEHL, MEGAN ANN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:DIEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ANN
Other - Last Name:KLEINERTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:3759 BUSINESS ROUTE 220 N.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522
Mailing Address - Country:US
Mailing Address - Phone:814-623-1212
Mailing Address - Fax:814-285-3023
Practice Address - Street 1:3759 BUSINESS ROUTE 220 N.
Practice Address - Street 2:SUITE 101
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522
Practice Address - Country:US
Practice Address - Phone:814-623-1212
Practice Address - Fax:814-285-3023
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133358104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker