Provider Demographics
NPI:1013495415
Name:MOREDOCK, MEGHAN KEELY (SLP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:KEELY
Last Name:MOREDOCK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 N MANNING DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1917
Mailing Address - Country:US
Mailing Address - Phone:309-265-2788
Mailing Address - Fax:
Practice Address - Street 1:7213 N ALLEN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1107
Practice Address - Country:US
Practice Address - Phone:309-258-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist