Provider Demographics
NPI:1851624761
Name:WACLAWSKI, MEGHAN COLEMAN (BCBA)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:COLEMAN
Last Name:WACLAWSKI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:ELIZABETH
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 33568
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3568
Mailing Address - Country:US
Mailing Address - Phone:855-223-7123
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:5333 MISSION CENTER RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1347
Practice Address - Country:US
Practice Address - Phone:552-237-1238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1054103K00000X
WABA60948501103K00000X
CA1-13-13826103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst