Provider Demographics
NPI:1518538636
Name:CLIFFORD, MEGHAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:SANOCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5693 CHESHIRE LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4022
Mailing Address - Country:US
Mailing Address - Phone:651-235-6369
Mailing Address - Fax:
Practice Address - Street 1:16204 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3405
Practice Address - Country:US
Practice Address - Phone:651-235-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6666103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist