Provider Demographics
NPI:1235685736
Name:HEUBERGER, MEGAN ROSE (SLP, MS, CCC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ROSE
Last Name:HEUBERGER
Suffix:
Gender:F
Credentials:SLP, MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:YAMHILL
Mailing Address - State:OR
Mailing Address - Zip Code:97148-8621
Mailing Address - Country:US
Mailing Address - Phone:541-227-4117
Mailing Address - Fax:
Practice Address - Street 1:255 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:YAMHILL
Practice Address - State:OR
Practice Address - Zip Code:97148-8621
Practice Address - Country:US
Practice Address - Phone:541-227-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR015170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist