Provider Demographics
NPI:1982891008
Name:REARDEN, MEGHAN D (SLP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:D
Last Name:REARDEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190675
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99519-0675
Mailing Address - Country:US
Mailing Address - Phone:907-282-4044
Mailing Address - Fax:
Practice Address - Street 1:161 KLEVIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1508
Practice Address - Country:US
Practice Address - Phone:907-561-8060
Practice Address - Fax:907-563-3172
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004715235Z00000X
AKSLPS487235Z00000X
MTSLP-SP-LIC-1269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7018518Medicaid
WA7018518Medicaid