Provider Demographics
NPI:1508009705
Name:BATEMAN, MEGAN GIBSON (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:GIBSON
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 DONNYBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6111
Mailing Address - Country:US
Mailing Address - Phone:903-561-2808
Mailing Address - Fax:903-939-1812
Practice Address - Street 1:627 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3355
Practice Address - Country:US
Practice Address - Phone:903-675-0000
Practice Address - Fax:903-675-5600
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0094BGOtherBCBSTX
TX1100190-02Medicaid
TX1100190-02Medicaid