Provider Demographics
NPI:1265573596
Name:STANGL MEDDAUGH, KELLY (CW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:STANGL MEDDAUGH
Suffix:
Gender:F
Credentials:CW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 CHESTNUT ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-2160
Mailing Address - Country:US
Mailing Address - Phone:610-948-2200
Mailing Address - Fax:610-948-2203
Practice Address - Street 1:550 PINETOWN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2605
Practice Address - Country:US
Practice Address - Phone:215-643-0200
Practice Address - Fax:215-643-9844
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0137981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7798213OtherAETNA
2321511000OtherPERSONAL CHOICE
PA344582000OtherMAGELLAN