Provider Demographics
NPI:1811310907
Name:LANG, MEGAN MARIE (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:LANG
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 1:171 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45744-7556
Mailing Address - Country:US
Mailing Address - Phone:740-336-8358
Mailing Address - Fax:
Practice Address - Street 1:510 5TH ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:OH
Practice Address - Zip Code:45715-8916
Practice Address - Country:US
Practice Address - Phone:740-984-2371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10890235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist