Provider Demographics
NPI:1124212675
Name:MEGAN PULLOS MA, CCC-SLP/L, LLC
Entity Type:Organization
Organization Name:MEGAN PULLOS MA, CCC-SLP/L, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN PULLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP/L
Authorized Official - Phone:630-301-0549
Mailing Address - Street 1:12708 SHENANDOAH TRL
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-4703
Mailing Address - Country:US
Mailing Address - Phone:630-301-0549
Mailing Address - Fax:815-254-8635
Practice Address - Street 1:12708 SHENANDOAH TRL
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-4703
Practice Address - Country:US
Practice Address - Phone:630-301-0549
Practice Address - Fax:815-254-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008257251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services