Provider Demographics
NPI:1619199643
Name:ANDERSON, MEGHAN W (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEGHAM
Other - Middle Name:G
Other - Last Name:WOOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:821 SAGE AVE.
Mailing Address - Street 2:
Mailing Address - City:KEMMERER
Mailing Address - State:WY
Mailing Address - Zip Code:83101-3113
Mailing Address - Country:US
Mailing Address - Phone:307-877-4466
Mailing Address - Fax:307-877-9832
Practice Address - Street 1:1050 N. HWY 414
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:WY
Practice Address - Zip Code:82939
Practice Address - Country:US
Practice Address - Phone:307-782-3097
Practice Address - Fax:307-782-3077
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-277641041C0700X
WYLCSW-7971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical