Provider Demographics
NPI:1396452082
Name:TEDROW, MEGAN MICHELLE
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:MICHELLE
Last Name:TEDROW
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 1:7960 RAFAEL RIVERA WAY UNIT 1371
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-5359
Mailing Address - Country:US
Mailing Address - Phone:916-729-9622
Mailing Address - Fax:
Practice Address - Street 1:3067 E WARM SPRINGS RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3750
Practice Address - Country:US
Practice Address - Phone:702-650-6508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health