Provider Demographics
NPI:1679941090
Name:KEARNEY, MEAGAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 1464
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-1464
Mailing Address - Country:US
Mailing Address - Phone:800-474-5153
Mailing Address - Fax:
Practice Address - Street 1:5301 TOMASINA RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6171
Practice Address - Country:US
Practice Address - Phone:800-474-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60587057235Z00000X
MT5945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist