Provider Demographics
NPI:1790006310
Name:WARDLOW, MEGAN K (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:K
Last Name:WARDLOW
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 1:804 STATE ST
Mailing Address - Street 2:#5
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4968
Mailing Address - Country:US
Mailing Address - Phone:217-224-1750
Mailing Address - Fax:217-224-0403
Practice Address - Street 1:804 STATE ST
Practice Address - Street 2:#5
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4968
Practice Address - Country:US
Practice Address - Phone:217-224-1750
Practice Address - Fax:217-224-0403
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist