Provider Demographics
NPI:1245770718
Name:WHITE, MEAGAN (MED, LSLS CERT AV)
Entity Type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MED, LSLS CERT AV
Other - Prefix:MISS
Other - First Name:MEAGAN
Other - Middle Name:S
Other - Last Name:DOWNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 COURTLAND HILL ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-2305
Mailing Address - Country:US
Mailing Address - Phone:914-649-0779
Mailing Address - Fax:
Practice Address - Street 1:54 COURTLAND HILL ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-2305
Practice Address - Country:US
Practice Address - Phone:914-649-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7295854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist