Provider Demographics
NPI:1831567262
Name:SMITH, MEGAN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SMITH
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 1:2461 10TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1201
Mailing Address - Country:US
Mailing Address - Phone:319-358-6323
Mailing Address - Fax:319-382-7822
Practice Address - Street 1:2461 10TH ST STE 203
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1201
Practice Address - Country:US
Practice Address - Phone:319-358-6323
Practice Address - Fax:319-382-7822
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist