Provider Demographics
NPI:1821788324
Name:SCHWALLER, MEGAN MELAINE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MELAINE
Last Name:SCHWALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 BONHOMME AVE STE 1800
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1931
Mailing Address - Country:US
Mailing Address - Phone:636-202-0693
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:7777 BONHOMME AVE STE 1800
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1931
Practice Address - Country:US
Practice Address - Phone:636-202-0693
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician