Provider Demographics
NPI:1578124129
Name:SMART, MEGAN LYNN (MA, LIC, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:SMART
Suffix:
Gender:F
Credentials:MA, LIC, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 POMACE CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6923
Mailing Address - Country:US
Mailing Address - Phone:925-699-4451
Mailing Address - Fax:
Practice Address - Street 1:60 FENTON ST STE 2
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4196
Practice Address - Country:US
Practice Address - Phone:925-743-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist