Provider Demographics
NPI:1366690042
Name:GARDNER, MEGAN LEA (SLP CFY)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEA
Last Name:GARDNER
Suffix:
Gender:F
Credentials:SLP CFY
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LEA
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP CFY
Mailing Address - Street 1:1689 E SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SUMNER
Mailing Address - State:NM
Mailing Address - Zip Code:88119-9370
Mailing Address - Country:US
Mailing Address - Phone:575-512-6247
Mailing Address - Fax:
Practice Address - Street 1:1600 SUTTER PL
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4611
Practice Address - Country:US
Practice Address - Phone:575-769-4490
Practice Address - Fax:575-935-0011
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist