Provider Demographics
NPI:1538489059
Name:LIVERMORE, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LIVERMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8721 W BARTELL DR
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:IL
Mailing Address - Zip Code:61547-9677
Mailing Address - Country:US
Mailing Address - Phone:309-657-6028
Mailing Address - Fax:
Practice Address - Street 1:4812 PFEIFFER RD
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:IL
Practice Address - Zip Code:61607-2647
Practice Address - Country:US
Practice Address - Phone:309-697-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist