Provider Demographics
NPI:1801049838
Name:WILLIAMSON, MEGAN LEE (MA, SLP)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:LEE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24242 SANTA CLARA AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2743
Mailing Address - Country:US
Mailing Address - Phone:949-581-8239
Mailing Address - Fax:
Practice Address - Street 1:23361 MADERO
Practice Address - Street 2:STE 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2715
Practice Address - Country:US
Practice Address - Phone:949-581-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist