Provider Demographics
NPI:1508925645
Name:MCCANN, MEGAN KAY (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:KAY
Last Name:MCCANN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25102 JEFFERSON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-1707
Mailing Address - Country:US
Mailing Address - Phone:951-460-1190
Mailing Address - Fax:951-461-7975
Practice Address - Street 1:25102 JEFFERSON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-1707
Practice Address - Country:US
Practice Address - Phone:951-460-1190
Practice Address - Fax:951-461-7975
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB229002Medicare PIN
CACA143791Medicare PIN
CACA143790Medicare PIN