Provider Demographics
NPI:1659981124
Name:MIDDLETON, MEIGHAN ROSE (LSW)
Entity Type:Individual
Prefix:
First Name:MEIGHAN
Middle Name:ROSE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LSW
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 580491
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55458-0491
Mailing Address - Country:US
Mailing Address - Phone:612-323-1040
Mailing Address - Fax:
Practice Address - Street 1:6111 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-2560
Practice Address - Country:US
Practice Address - Phone:612-323-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24434104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker