Provider Demographics
NPI:1700169968
Name:DWYER, MEAGAN LEIGH (PHD)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:LEIGH
Last Name:DWYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:LEIGH
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 WARM SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2259
Mailing Address - Country:US
Mailing Address - Phone:314-779-5595
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2937
Practice Address - Country:US
Practice Address - Phone:314-588-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010041438103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical