Provider Demographics
NPI:1639591902
Name:BEAVER, MEGAN BRIANNE (MS, SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:BRIANNE
Last Name:BEAVER
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:BRIANNE
Other - Last Name:SHARSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:706 17TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-2834
Mailing Address - Country:US
Mailing Address - Phone:218-349-3534
Mailing Address - Fax:
Practice Address - Street 1:615 BECKER AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3233
Practice Address - Country:US
Practice Address - Phone:320-214-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist