Provider Demographics
NPI:1770749251
Name:KRODEL, MEGHAN ANNE (MA, CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:ANNE
Last Name:KRODEL
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6126
Mailing Address - Country:US
Mailing Address - Phone:860-432-1683
Mailing Address - Fax:
Practice Address - Street 1:71 WELLS ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6126
Practice Address - Country:US
Practice Address - Phone:860-432-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist