Provider Demographics
NPI:1568148807
Name:WIRTH, MEGAN ROSE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ROSE
Last Name:WIRTH
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 1:7711 FREELAND CT
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-1658
Mailing Address - Country:US
Mailing Address - Phone:414-344-8245
Mailing Address - Fax:414-509-1630
Practice Address - Street 1:7711 FREELAND CT
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1658
Practice Address - Country:US
Practice Address - Phone:414-210-0088
Practice Address - Fax:414-509-1630
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6195-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist