Provider Demographics
NPI:1518243658
Name:EXNER, MEGAN ELIZABETH (MA CCC-SP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:EXNER
Suffix:
Gender:F
Credentials:MA CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 W CENTRAL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1470
Mailing Address - Country:US
Mailing Address - Phone:740-369-3650
Mailing Address - Fax:740-369-0812
Practice Address - Street 1:494 W CENTRAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1470
Practice Address - Country:US
Practice Address - Phone:740-369-3650
Practice Address - Fax:740-369-0812
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP10092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2095245Medicaid