Provider Demographics
NPI:1316202658
Name:WALSH, MEGAN ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ROSE
Last Name:WALSH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:ROSE
Other - Last Name:STARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:5004 TOWN HALL RD
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-3715
Mailing Address - Country:US
Mailing Address - Phone:608-778-4209
Mailing Address - Fax:
Practice Address - Street 1:700 GENEVA PKWY N
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4594
Practice Address - Country:US
Practice Address - Phone:262-249-3508
Practice Address - Fax:262-249-7955
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3605-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist