Provider Demographics
NPI:1982853099
Name:BRANSTNER, MEGAN FRANCES
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:FRANCES
Last Name:BRANSTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:FRANCES
Other - Last Name:MCEWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:641 REDRUTH AVE
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1979
Mailing Address - Country:US
Mailing Address - Phone:248-941-3046
Mailing Address - Fax:
Practice Address - Street 1:450 BREWER RD
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:MI
Practice Address - Zip Code:48367-4008
Practice Address - Country:US
Practice Address - Phone:586-944-4790
Practice Address - Fax:248-800-3336
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010911791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid