Provider Demographics
NPI:1053695726
Name:GEWECKE, MEGAN MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MICHELLE
Last Name:GEWECKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:MICHELLE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2804 2ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847
Mailing Address - Country:US
Mailing Address - Phone:308-455-8605
Mailing Address - Fax:308-455-8606
Practice Address - Street 1:2804 2ND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3500
Practice Address - Country:US
Practice Address - Phone:308-455-8605
Practice Address - Fax:308-455-8606
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist