Provider Demographics
NPI:1104516947
Name:MEGALI, MEGAN ROSE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ROSE
Last Name:MEGALI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ROSE
Other - Last Name:BROCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1219 OHIO ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3923
Mailing Address - Country:US
Mailing Address - Phone:812-328-7300
Mailing Address - Fax:812-328-7400
Practice Address - Street 1:2901 OHIO BLVD STE 235
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2239
Practice Address - Country:US
Practice Address - Phone:812-328-7300
Practice Address - Fax:812-328-7400
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007652A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist