Provider Demographics
NPI:1154642312
Name:CROSS, MEGAN NICHOLE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICHOLE
Last Name:CROSS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 LANDON WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4553
Mailing Address - Country:US
Mailing Address - Phone:270-303-3285
Mailing Address - Fax:
Practice Address - Street 1:3013 LANDON WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4553
Practice Address - Country:US
Practice Address - Phone:270-303-3285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3673Medicare UPIN