Provider Demographics
NPI:1114448453
Name:CHILDERS, MEGAN MARIE (HIS)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:MARIE
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 MADISON BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2042
Mailing Address - Country:US
Mailing Address - Phone:256-319-4327
Mailing Address - Fax:
Practice Address - Street 1:4205 BALMORAL DR SW STE 201
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7421
Practice Address - Country:US
Practice Address - Phone:256-489-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2290237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist