Provider Demographics
NPI:1720358898
Name:TREGNAGO, MEGAN KATHLEEN (MED, MHA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:TREGNAGO
Suffix:
Gender:F
Credentials:MED, MHA, BCBA, LBA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:KATHLEEN
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, MHA, BCBA, LBA
Mailing Address - Street 1:107 WAUGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5085
Mailing Address - Country:US
Mailing Address - Phone:573-874-3777
Mailing Address - Fax:573-874-3880
Practice Address - Street 1:107 WAUGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5085
Practice Address - Country:US
Practice Address - Phone:573-874-3777
Practice Address - Fax:573-874-3880
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011038192103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst