Provider Demographics
NPI:1598388084
Name:CHURCH, MEGAN THERESE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:THERESE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:THERESE
Other - Last Name:NARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:3100 NC-55
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519
Mailing Address - Country:US
Mailing Address - Phone:919-338-1522
Mailing Address - Fax:919-229-4993
Practice Address - Street 1:3100 NC-55
Practice Address - Street 2:SUITE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519
Practice Address - Country:US
Practice Address - Phone:919-338-1522
Practice Address - Fax:919-229-4993
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14161235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist