Provider Demographics
NPI:1700207537
Name:WEBER, MEGAN THERESE (ASL)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:THERESE
Last Name:WEBER
Suffix:
Gender:F
Credentials:ASL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 CARSON TRL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4524
Mailing Address - Country:US
Mailing Address - Phone:505-220-6409
Mailing Address - Fax:
Practice Address - Street 1:1115 N CALIFORNIA ST.
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801
Practice Address - Country:US
Practice Address - Phone:575-838-0800
Practice Address - Fax:575-838-3999
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM48452355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant