Provider Demographics
NPI:1881259133
Name:FRY, MEGAN JULIA LANDIS (SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JULIA LANDIS
Last Name:FRY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JULIA
Other - Last Name:LANDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3020
Mailing Address - Country:US
Mailing Address - Phone:717-201-5357
Mailing Address - Fax:
Practice Address - Street 1:200 SKILES BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7321
Practice Address - Country:US
Practice Address - Phone:610-455-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist