Provider Demographics
NPI:1326466004
Name:VANDEPOL, MEGAN MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:VANDEPOL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8733 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MI
Mailing Address - Zip Code:49665-8010
Mailing Address - Country:US
Mailing Address - Phone:517-614-3146
Mailing Address - Fax:
Practice Address - Street 1:8733 23 MILE RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MI
Practice Address - Zip Code:49665-8010
Practice Address - Country:US
Practice Address - Phone:517-614-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000727235Z00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist