Provider Demographics
NPI:1780099630
Name:SMITH, MEGHAN CATHLEEN (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:CATHLEEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 120TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3508
Mailing Address - Country:US
Mailing Address - Phone:718-935-4000
Mailing Address - Fax:
Practice Address - Street 1:588 NAVAHO TRL
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-2808
Practice Address - Country:US
Practice Address - Phone:201-788-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-29
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023018-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist