Provider Demographics
NPI:1659147908
Name:TREFFEISEN, MEGAN (MED)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:TREFFEISEN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:LISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 HERITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-8726
Mailing Address - Country:US
Mailing Address - Phone:515-030-3387
Mailing Address - Fax:
Practice Address - Street 1:400 HERITAGE AVE
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-8726
Practice Address - Country:US
Practice Address - Phone:515-030-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11246235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist