Provider Demographics
NPI:1649797986
Name:GREEBON KOERTH, MEGAN EMILY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:EMILY
Last Name:GREEBON KOERTH
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 1:3920 LELAND ST APT D1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1044
Mailing Address - Country:US
Mailing Address - Phone:830-448-9665
Mailing Address - Fax:
Practice Address - Street 1:8840 N MAGNOLIA AVE STE 220
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4516
Practice Address - Country:US
Practice Address - Phone:619-692-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist