Provider Demographics
NPI:1083995047
Name:MCCORMICK, MEGAN ELIZABETH (SLP)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 W CARSON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5736
Mailing Address - Country:US
Mailing Address - Phone:310-948-2258
Mailing Address - Fax:
Practice Address - Street 1:3424 W CARSON ST STE 210
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5736
Practice Address - Country:US
Practice Address - Phone:310-948-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17199235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist