Provider Demographics
NPI:1245920453
Name:TEALE, MEGAN E (LADC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:TEALE
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 1:116 OAK LN
Mailing Address - Street 2:
Mailing Address - City:FORESTON
Mailing Address - State:MN
Mailing Address - Zip Code:56330-4508
Mailing Address - Country:US
Mailing Address - Phone:763-370-7679
Mailing Address - Fax:
Practice Address - Street 1:116 OAK LN
Practice Address - Street 2:
Practice Address - City:FORESTON
Practice Address - State:MN
Practice Address - Zip Code:56330-4508
Practice Address - Country:US
Practice Address - Phone:763-370-7679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304559101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)