Provider Demographics
NPI:1740793405
Name:MCMASTER-STINE, MEGAN LEIGH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEIGH
Last Name:MCMASTER-STINE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W HAYDEN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8720
Mailing Address - Country:US
Mailing Address - Phone:208-660-9463
Mailing Address - Fax:208-908-0044
Practice Address - Street 1:1130 W HAYDEN AVE STE 103
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8720
Practice Address - Country:US
Practice Address - Phone:208-660-9463
Practice Address - Fax:208-908-0044
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-3727235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist