Provider Demographics
NPI:1316213010
Name:MASON, MEGAN GABRIELLE (SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:GABRIELLE
Last Name:MASON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:GABRIELLE
Other - Last Name:ROFFERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1409 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-5822
Mailing Address - Country:US
Mailing Address - Phone:432-270-3422
Mailing Address - Fax:325-236-6112
Practice Address - Street 1:1104 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-6450
Practice Address - Country:US
Practice Address - Phone:325-236-6821
Practice Address - Fax:325-236-6112
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist