Provider Demographics
NPI:1578056461
Name:SLOCUM, MEGAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:COGAN STATION
Mailing Address - State:PA
Mailing Address - Zip Code:17728-9500
Mailing Address - Country:US
Mailing Address - Phone:570-250-4845
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:53 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:COGAN STATION
Practice Address - State:PA
Practice Address - Zip Code:17728-9500
Practice Address - Country:US
Practice Address - Phone:570-250-4845
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA011908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist