Provider Demographics
NPI:1982182069
Name:HAWK, MEGAN AMANDA (CDCA, LMT, CPHT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:AMANDA
Last Name:HAWK
Suffix:
Gender:F
Credentials:CDCA, LMT, CPHT
Other - Prefix:MRS
Other - First Name:MEGAN
Other - Middle Name:AMANDA
Other - Last Name:NICKELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA, LMT, CPHT
Mailing Address - Street 1:118 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1619
Mailing Address - Country:US
Mailing Address - Phone:937-599-1975
Mailing Address - Fax:
Practice Address - Street 1:118 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1619
Practice Address - Country:US
Practice Address - Phone:937-599-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH166076171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty