Provider Demographics
NPI:1477606382
Name:PETRIZIO, MEGAN ANNE (MA-CCC, SLP)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ANNE
Last Name:PETRIZIO
Suffix:
Gender:F
Credentials:MA-CCC, SLP
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:ANNE
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA-CCC, SLP
Mailing Address - Street 1:913 PRESIDENT ST
Mailing Address - Street 2:APT. 3B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1648
Mailing Address - Country:US
Mailing Address - Phone:619-559-4440
Mailing Address - Fax:
Practice Address - Street 1:913 PRESIDENT ST
Practice Address - Street 2:APT. 3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1648
Practice Address - Country:US
Practice Address - Phone:619-559-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist