Provider Demographics
NPI:1295870996
Name:FALLON, MARGARET A (PHD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:A
Last Name:FALLON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARGO
Other - Middle Name:A
Other - Last Name:FALLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 19491
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66285-9491
Mailing Address - Country:US
Mailing Address - Phone:913-789-7899
Mailing Address - Fax:913-901-8225
Practice Address - Street 1:STATELINE EXECUTIVE OFFICE PARK
Practice Address - Street 2:8010 STATELINE RD.
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208
Practice Address - Country:US
Practice Address - Phone:913-789-7899
Practice Address - Fax:913-901-8225
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPSYC 01385103T00000X
KS2612103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495421000Medicaid