Provider Demographics
NPI:1467170373
Name:GURA, MEGAN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GURA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8114 W BECK LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-4858
Mailing Address - Country:US
Mailing Address - Phone:815-236-0189
Mailing Address - Fax:
Practice Address - Street 1:1802 W PARKSIDE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1322
Practice Address - Country:US
Practice Address - Phone:602-943-5472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP13850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist