Provider Demographics
NPI:1376998674
Name:DUBOIS, MEGAN (SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 UTICA RIDGE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1657
Mailing Address - Country:US
Mailing Address - Phone:563-327-0132
Mailing Address - Fax:
Practice Address - Street 1:3740 UTICA RIDGE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1657
Practice Address - Country:US
Practice Address - Phone:563-327-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist