Provider Demographics
NPI:1790012136
Name:FARLEY, MEGAN ANNETTE (PHD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANNETTE
Last Name:FARLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 TIERNEY DR
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2313
Mailing Address - Country:US
Mailing Address - Phone:801-574-5074
Mailing Address - Fax:
Practice Address - Street 1:1903 TIERNEY DR
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2313
Practice Address - Country:US
Practice Address - Phone:801-574-5074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3118-57103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical