Provider Demographics
NPI:1740621408
Name:MARTIN, MEGAN LEANN (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LEANN
Last Name:MARTIN
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 1:3807 EAGLE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1064
Mailing Address - Country:US
Mailing Address - Phone:217-821-3455
Mailing Address - Fax:
Practice Address - Street 1:3807 EAGLE VIEW CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1064
Practice Address - Country:US
Practice Address - Phone:217-821-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013005307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist