Provider Demographics
NPI:1023165677
Name:LIEBER, MEAGAN E (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:E
Last Name:LIEBER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:E
Other - Last Name:MAKOVEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2520 W. MAIN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4214
Mailing Address - Country:US
Mailing Address - Phone:501-982-0528
Mailing Address - Fax:501-533-6327
Practice Address - Street 1:2400 W. MAIN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4212
Practice Address - Country:US
Practice Address - Phone:501-982-0528
Practice Address - Fax:501-533-6327
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP7929235Z00000X
AR12096018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158603721Medicaid
AR5Y799OtherBCBS