Provider Demographics
NPI:1629313580
Name:HENDRICKSON, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HENDRICKSON
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 1:854 POOL ST APT 50
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6062
Mailing Address - Country:US
Mailing Address - Phone:307-399-1459
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3758
Practice Address - Country:US
Practice Address - Phone:541-686-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker