Provider Demographics
NPI:1750835112
Name:BURTRAW, MEGAN E (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:BURTRAW
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 GREATSTONE PT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3274
Mailing Address - Country:US
Mailing Address - Phone:859-224-4081
Mailing Address - Fax:859-224-4082
Practice Address - Street 1:2412 GREATSTONE PT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3274
Practice Address - Country:US
Practice Address - Phone:859-224-4081
Practice Address - Fax:859-224-4082
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169028235Z00000X
KY173570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist