Provider Demographics
NPI:1871189126
Name:FOSHA, MEAGAN KELLEY- MCKENNON (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:KELLEY- MCKENNON
Last Name:FOSHA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 HELMSFORD DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2688
Mailing Address - Country:US
Mailing Address - Phone:214-701-5171
Mailing Address - Fax:
Practice Address - Street 1:400A HIGH SCHOOL DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3635
Practice Address - Country:US
Practice Address - Phone:469-713-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist