Provider Demographics
NPI:1477792737
Name:WEATHERS, MEGAN (MED SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:MED SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 AUTUMN BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1406
Mailing Address - Country:US
Mailing Address - Phone:503-508-7493
Mailing Address - Fax:
Practice Address - Street 1:79 AUTUMN BRANCH DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1406
Practice Address - Country:US
Practice Address - Phone:503-508-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22827235Z00000X
TX108212235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist