Provider Demographics
NPI:1790863793
Name:NICHOLS, MEGAN A (MS)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:A
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 46TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-1443
Mailing Address - Country:US
Mailing Address - Phone:843-458-1362
Mailing Address - Fax:
Practice Address - Street 1:915 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4116
Practice Address - Country:US
Practice Address - Phone:843-449-6449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist