Provider Demographics
NPI:1255001186
Name:MATHIASEN, MEGAN (SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MATHIASEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:PAOLUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:172 E SAINT CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3554
Mailing Address - Country:US
Mailing Address - Phone:815-501-3779
Mailing Address - Fax:
Practice Address - Street 1:4020 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4416
Practice Address - Country:US
Practice Address - Phone:331-301-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist