Provider Demographics
NPI:1982857009
Name:LILLEY, MEGAN MCDONOUGH (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MCDONOUGH
Last Name:LILLEY
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 1:6634 HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1112
Mailing Address - Country:US
Mailing Address - Phone:716-438-2288
Mailing Address - Fax:
Practice Address - Street 1:603 DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4461
Practice Address - Country:US
Practice Address - Phone:716-692-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist