Provider Demographics
NPI:1609313683
Name:BRANDKAMP, MEGAN ANNE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:ANNE
Last Name:BRANDKAMP
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 DOCK ST
Mailing Address - Street 2:#104
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4614
Mailing Address - Country:US
Mailing Address - Phone:253-874-9300
Mailing Address - Fax:206-374-2533
Practice Address - Street 1:535 DOCK ST
Practice Address - Street 2:#104
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4614
Practice Address - Country:US
Practice Address - Phone:253-874-9300
Practice Address - Fax:206-374-2533
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60637803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist