Provider Demographics
NPI:1881962538
Name:WISKIRCHEN, MEGAN KAE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KAE
Last Name:WISKIRCHEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 S BRAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5309
Mailing Address - Country:US
Mailing Address - Phone:801-641-4442
Mailing Address - Fax:
Practice Address - Street 1:3303 S BRAMPTON WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5309
Practice Address - Country:US
Practice Address - Phone:801-641-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist