Provider Demographics
NPI:1205507266
Name:WATERS, MEGAN RALYNN (BA, CADC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RALYNN
Last Name:WATERS
Suffix:
Gender:F
Credentials:BA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-2116
Mailing Address - Country:US
Mailing Address - Phone:515-385-2433
Mailing Address - Fax:515-386-2124
Practice Address - Street 1:102 N WILSON AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-2116
Practice Address - Country:US
Practice Address - Phone:515-385-2433
Practice Address - Fax:515-386-2124
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20034101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)