Provider Demographics
NPI:1407067390
Name:BREWER, MEG T (MA)
Entity Type:Individual
Prefix:MS
First Name:MEG
Middle Name:T
Last Name:BREWER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 N MAIN ST UNIT 9
Mailing Address - Street 2:MAIL UNIT 10
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9681
Mailing Address - Country:US
Mailing Address - Phone:574-247-6047
Mailing Address - Fax:574-247-6060
Practice Address - Street 1:6910 N MAIN ST UNIT 9
Practice Address - Street 2:MAIL UNIT 10
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9681
Practice Address - Country:US
Practice Address - Phone:574-247-6047
Practice Address - Fax:574-247-6060
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004168A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200222600Medicaid