Provider Demographics
NPI:1396419099
Name:ROTHSTEIN, MEGAN ALISEN
Entity Type:Individual
Prefix:
First Name:MEGAN ALISEN
Middle Name:
Last Name:ROTHSTEIN
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 1:11590 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55341-4529
Mailing Address - Country:US
Mailing Address - Phone:612-235-6259
Mailing Address - Fax:
Practice Address - Street 1:2118 BLAISDELL AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2415
Practice Address - Country:US
Practice Address - Phone:612-235-6259
Practice Address - Fax:612-872-8855
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304961101YA0400X
MN3671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)