Provider Demographics
NPI:1184058299
Name:LEU, MEGHAN ELIZABETH (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:LEU
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:MEGHAN
Other - Middle Name:ELIZABETH
Other - Last Name:CULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CF-SLP
Mailing Address - Street 1:2724 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-6305
Mailing Address - Country:US
Mailing Address - Phone:513-560-3736
Mailing Address - Fax:
Practice Address - Street 1:11602 LAKE UNDERHILL ROAD
Practice Address - Street 2:SUITE 129
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4460
Practice Address - Country:US
Practice Address - Phone:407-277-5400
Practice Address - Fax:321-281-4942
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009466800Medicaid