Provider Demographics
NPI:1184120404
Name:WAHL, MEGHAN ELIZABETH (AAS)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:WAHL
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:COPPER CENTER
Mailing Address - State:AK
Mailing Address - Zip Code:99573-0508
Mailing Address - Country:US
Mailing Address - Phone:907-822-8882
Mailing Address - Fax:
Practice Address - Street 1:111.5 RICHARDSON HWY
Practice Address - Street 2:
Practice Address - City:COPPER CENTER
Practice Address - State:AK
Practice Address - Zip Code:99573
Practice Address - Country:US
Practice Address - Phone:907-822-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician