Provider Demographics
NPI:1639404924
Name:MIRASOLA, MEGAN ELIZABETH (MS)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:MIRASOLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-2375
Mailing Address - Country:US
Mailing Address - Phone:740-264-7176
Mailing Address - Fax:
Practice Address - Street 1:256 JOHN SCOTT HWY
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952
Practice Address - Country:US
Practice Address - Phone:740-264-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4574235Z00000X
OH10193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist