Provider Demographics
NPI:1275016164
Name:ANDERSON, MEGAN TAYLOR (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:TAYLOR
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BOOMER RD
Mailing Address - Street 2:
Mailing Address - City:HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07843-1302
Mailing Address - Country:US
Mailing Address - Phone:973-698-0967
Mailing Address - Fax:
Practice Address - Street 1:2 BOOMER RD
Practice Address - Street 2:
Practice Address - City:HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07843-1302
Practice Address - Country:US
Practice Address - Phone:973-698-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-3113235Z00000X
NJ1102067235Z00000X
NJ41YS00999000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist