Provider Demographics
NPI:1568719839
Name:GALLAGHER, MEGAN KATHLEEN (CADC I)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92125
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-2125
Mailing Address - Country:US
Mailing Address - Phone:503-419-2672
Mailing Address - Fax:503-253-4643
Practice Address - Street 1:1949 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1303
Practice Address - Country:US
Practice Address - Phone:503-419-2672
Practice Address - Fax:503-253-4643
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-09-22101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR13-09-22OtherACCBO CADC CERTIFICATION NO.