Provider Demographics
NPI:1952713661
Name:MAHAN, MEGHAN MCMILLIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:MCMILLIN
Last Name:MAHAN
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 1:2024 GRASMERE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1508
Mailing Address - Country:US
Mailing Address - Phone:405-880-1086
Mailing Address - Fax:
Practice Address - Street 1:2024 GRASMERE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1508
Practice Address - Country:US
Practice Address - Phone:405-880-1086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist