Provider Demographics
NPI:1184250011
Name:HEIN, MEGAN MARIE (LADC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:HEIN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 PIERCE AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-2250
Mailing Address - Country:US
Mailing Address - Phone:507-229-0350
Mailing Address - Fax:507-216-0371
Practice Address - Street 1:360 PIERCE AVE STE 206
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-2250
Practice Address - Country:US
Practice Address - Phone:507-229-0350
Practice Address - Fax:507-216-0371
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304698101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)