Provider Demographics
NPI:1679896310
Name:MEGAN J SPAWN, INC.
Entity Type:Organization
Organization Name:MEGAN J SPAWN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SPAWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-MH
Authorized Official - Phone:605-275-2277
Mailing Address - Street 1:5000 S BROADBAND LN
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2260
Mailing Address - Country:US
Mailing Address - Phone:605-275-2277
Mailing Address - Fax:605-275-2279
Practice Address - Street 1:5000 S BROADBAND LN
Practice Address - Street 2:SUITE 107
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2260
Practice Address - Country:US
Practice Address - Phone:605-275-2277
Practice Address - Fax:605-275-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6576530Medicaid