Provider Demographics
NPI:1114384336
Name:MACOMBER, MEGHAN KATHLEEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:KATHLEEN
Last Name:MACOMBER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:KATHLEEN
Other - Last Name:O'GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:446 SAINT DAVIDS AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4203
Mailing Address - Country:US
Mailing Address - Phone:610-724-2574
Mailing Address - Fax:
Practice Address - Street 1:446 SAINT DAVIDS AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-4203
Practice Address - Country:US
Practice Address - Phone:610-724-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist