Provider Demographics
NPI:1639649676
Name:BAGLEY, MEGAN ASHLEY (SUDP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ASHLEY
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 WALL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1431
Mailing Address - Country:US
Mailing Address - Phone:206-441-3043
Mailing Address - Fax:206-441-4155
Practice Address - Street 1:2120 S PLUM ST STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4539
Practice Address - Country:US
Practice Address - Phone:206-441-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60741359171M00000X
WACP61034181101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator