Provider Demographics
NPI:1679903785
Name:MUGAN, MERRI ALLISON (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MERRI
Middle Name:ALLISON
Last Name:MUGAN
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 BREEZEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6908
Mailing Address - Country:US
Mailing Address - Phone:864-633-5647
Mailing Address - Fax:864-633-5643
Practice Address - Street 1:952 BREEZEWOOD CT
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6908
Practice Address - Country:US
Practice Address - Phone:864-633-5647
Practice Address - Fax:864-633-5643
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1425Medicaid