Provider Demographics
NPI:1457717720
Name:TEQUERO, MEGAN (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:TEQUERO
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 KIRTS BLVD
Mailing Address - Street 2:STE 305
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4892
Mailing Address - Country:US
Mailing Address - Phone:248-760-2121
Mailing Address - Fax:248-686-2498
Practice Address - Street 1:1025 E MAPLE RD
Practice Address - Street 2:SUITE B11
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6426
Practice Address - Country:US
Practice Address - Phone:248-760-2121
Practice Address - Fax:248-686-2498
Is Sole Proprietor?:No
Enumeration Date:2016-01-02
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist