Provider Demographics
NPI:1407300239
Name:KINNEAR, MEGAN MARIE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:KINNEAR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3643 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3619
Mailing Address - Country:US
Mailing Address - Phone:330-225-7731
Mailing Address - Fax:
Practice Address - Street 1:300 W 130TH ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2309
Practice Address - Country:US
Practice Address - Phone:330-225-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist