Provider Demographics
NPI:1447715289
Name:GROGG MEADOR, KAYLA RENEE (MSW, LGSW)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:RENEE
Last Name:GROGG MEADOR
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:MS
Other - First Name:KAYLA
Other - Middle Name:RENEE
Other - Last Name:GROGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:101 SUMMITS RDG
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8404
Mailing Address - Country:US
Mailing Address - Phone:304-820-5620
Mailing Address - Fax:
Practice Address - Street 1:425 INDUSTRIAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2287
Practice Address - Country:US
Practice Address - Phone:304-914-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009451671041C0700X
WVBP00945167104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical