Provider Demographics
NPI:1942619440
Name:LASLOW, MEGAN (MED EDS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LASLOW
Suffix:
Gender:F
Credentials:MED EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 AMRINE MILL RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1004
Mailing Address - Country:US
Mailing Address - Phone:937-243-8740
Mailing Address - Fax:
Practice Address - Street 1:800 AMRINE MILL RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1004
Practice Address - Country:US
Practice Address - Phone:937-243-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3175648103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool