Provider Demographics
NPI:1073744579
Name:GEARHART, MEGAN (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GEARHART
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2605
Mailing Address - Country:US
Mailing Address - Phone:570-274-9245
Mailing Address - Fax:
Practice Address - Street 1:204 EAGLE VALLEY MALL
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1315
Practice Address - Country:US
Practice Address - Phone:570-424-1706
Practice Address - Fax:570-424-6711
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA394532OtherMEDICARE