Provider Demographics
NPI:1013161983
Name:BOLLER, MEGARA FITZGIBBONS (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGARA
Middle Name:FITZGIBBONS
Last Name:BOLLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:MEGARA
Other - Middle Name:EILEEN
Other - Last Name:FITZGIBBONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, TSHH
Mailing Address - Street 1:1000 ELMWOOD AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-271-0680
Mailing Address - Fax:585-271-6977
Practice Address - Street 1:1000 ELMWOOD AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-271-0680
Practice Address - Fax:585-271-6977
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018G12-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist