Provider Demographics
NPI:1184344913
Name:VON RUEDEN, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:VON RUEDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 SOOTER RD
Mailing Address - Street 2:
Mailing Address - City:UNDERWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98651-9045
Mailing Address - Country:US
Mailing Address - Phone:512-587-2694
Mailing Address - Fax:
Practice Address - Street 1:161 SOOTER RD
Practice Address - Street 2:
Practice Address - City:UNDERWOOD
Practice Address - State:WA
Practice Address - Zip Code:98651-9045
Practice Address - Country:US
Practice Address - Phone:512-587-2694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORR8444101YM0800X
WAMC61454265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health