Provider Demographics
NPI:1174018345
Name:PALACIOS, MEGAN CATHERINE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:CATHERINE
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 N FORT VALLEY RD APT 126
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1289
Mailing Address - Country:US
Mailing Address - Phone:805-624-2331
Mailing Address - Fax:
Practice Address - Street 1:1718 N FORT VALLEY RD APT 126
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1289
Practice Address - Country:US
Practice Address - Phone:805-624-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SLPA112682355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant