Provider Demographics
NPI:1730468000
Name:JOHANSEN, MEAGHAN MORLEY AMENT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEAGHAN
Middle Name:MORLEY AMENT
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MEG
Other - Middle Name:MORELY AMENT
Other - Last Name:JOHANSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1407 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-3715
Mailing Address - Country:US
Mailing Address - Phone:507-934-2652
Mailing Address - Fax:507-934-2654
Practice Address - Street 1:1407 S STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-3715
Practice Address - Country:US
Practice Address - Phone:507-934-2652
Practice Address - Fax:507-934-2654
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist