Provider Demographics
NPI:1174672570
Name:CALLA, MEGHAN MCKENNA (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:MCKENNA
Last Name:CALLA
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 ACKLINS RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7750
Mailing Address - Country:US
Mailing Address - Phone:813-990-7170
Mailing Address - Fax:
Practice Address - Street 1:2608 ACKLINS RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7750
Practice Address - Country:US
Practice Address - Phone:813-990-7170
Practice Address - Fax:561-225-1718
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ3947235Z00000X
FLSA 9463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891539300Medicaid