Provider Demographics
NPI:1164293833
Name:JOHNSTON, MEGAN AMY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:AMY
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 E JOLIET HWY
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2032
Mailing Address - Country:US
Mailing Address - Phone:815-641-2966
Mailing Address - Fax:
Practice Address - Street 1:917 E JOLIET HWY
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2032
Practice Address - Country:US
Practice Address - Phone:815-641-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.017119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist