Provider Demographics
NPI:1346323219
Name:NICOLOFF, MEGAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:NICOLOFF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 HIGH ST SE
Mailing Address - Street 2:SUITE 206 C
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3660
Mailing Address - Country:US
Mailing Address - Phone:503-364-4039
Mailing Address - Fax:503-364-4059
Practice Address - Street 1:161 HIGH ST SE
Practice Address - Street 2:SUITE 206 C
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3660
Practice Address - Country:US
Practice Address - Phone:503-364-4039
Practice Address - Fax:503-364-4059
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1691103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist