Provider Demographics
NPI:1649703489
Name:CORBRIDGE, MEGAN (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CORBRIDGE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:BLOUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6871 JACK LONDON DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-4755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8835 NORTHPARK CT
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-3018
Practice Address - Country:US
Practice Address - Phone:770-513-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-08
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 106S00000X
IA105801103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician