Provider Demographics
NPI:1457007908
Name:WALCZAK, MEAGAN MAE (AUD CCCA FAAA ABA)
Entity Type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:MAE
Last Name:WALCZAK
Suffix:
Gender:F
Credentials:AUD CCCA FAAA ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3105
Mailing Address - Country:US
Mailing Address - Phone:413-575-0554
Mailing Address - Fax:
Practice Address - Street 1:102 SHORE DR STE 400
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3154
Practice Address - Country:US
Practice Address - Phone:508-502-7851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4901-SP-AU231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist