Provider Demographics
NPI:1043795065
Name:O'MALLEY, MEGHAN GRACE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:GRACE
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N COLUMBUS BLVD APT 912
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1461
Mailing Address - Country:US
Mailing Address - Phone:570-234-6140
Mailing Address - Fax:
Practice Address - Street 1:4712 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3513
Practice Address - Country:US
Practice Address - Phone:215-727-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSL000465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist