Provider Demographics
NPI:1235771569
Name:GONCALVES, MEGAN ANIELA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ANIELA
Last Name:GONCALVES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BARRY RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3326
Mailing Address - Country:US
Mailing Address - Phone:860-987-8829
Mailing Address - Fax:
Practice Address - Street 1:5 CONE ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2502
Practice Address - Country:US
Practice Address - Phone:860-695-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist