Provider Demographics
NPI:1336620095
Name:MADERE, MEAGAN ELIZABETH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ELIZABETH
Last Name:MADERE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 STERLING HART DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75428-3911
Mailing Address - Country:US
Mailing Address - Phone:903-886-2510
Mailing Address - Fax:903-886-3538
Practice Address - Street 1:2901 STERLING HART DR
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-3911
Practice Address - Country:US
Practice Address - Phone:903-886-2510
Practice Address - Fax:903-886-3538
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111555235Z00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter