Most Relevant Information
Provider Data
| NPI Number: | 1003459181 |
| Provider Name: | MEGAN GORDON |
| Entity Type: | Individual |
| Taxonomy Code: | 167G00000X |
| Specialty: | Licensed Psychiatric Technician |
| License Number: | PT22049 |
Most Important Dates
| Enumeration Date: | 10/22/2019 |
| Last Updated: | 10/22/2019 |
Provider Practice Location
327 COLLEGE AVE
SANTA ROSA
CA
954015117
Practice Location Phone/Fax
| Phone: | 7075682800 |
| Fax: |
Provider Mailing Location
2390 DONNA MARIA WAY
SANTA ROSA
CA
954015789
Provider Mailing Phone/Fax
| Phone: | 7076962725 |
| Fax: |