Provider Demographics
NPI:1528572245
Name:COCKRAM, MEAGAN WINTERLUDE (SLP ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:WINTERLUDE
Last Name:COCKRAM
Suffix:
Gender:F
Credentials:SLP ASSISTANT
Other - Prefix:MS
Other - First Name:MEAGAN
Other - Middle Name:WINTERLUDE
Other - Last Name:COCKRAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4300 SIGMA RD STE 130
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4445
Mailing Address - Country:US
Mailing Address - Phone:972-756-0500
Mailing Address - Fax:
Practice Address - Street 1:4300 SIGMA RD STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4445
Practice Address - Country:US
Practice Address - Phone:972-756-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX356132355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant