Provider Demographics
NPI:1982004776
Name:SEIDEMAN, MEGAN CARROLL (MHS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:CARROLL
Last Name:SEIDEMAN
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1109
Mailing Address - Country:US
Mailing Address - Phone:636-462-5078
Mailing Address - Fax:636-462-5079
Practice Address - Street 1:711 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1109
Practice Address - Country:US
Practice Address - Phone:636-462-5078
Practice Address - Fax:636-462-5079
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012022386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist