Provider Demographics
NPI:1649682493
Name:MUSSO, MEGAN SMITH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:SMITH
Last Name:MUSSO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 5TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-2155
Mailing Address - Country:US
Mailing Address - Phone:337-419-0086
Mailing Address - Fax:
Practice Address - Street 1:852 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-6120
Practice Address - Country:US
Practice Address - Phone:337-419-0086
Practice Address - Fax:337-415-0626
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist