Provider Demographics
NPI:1124740394
Name:SEYDOW, MEGAN ALEXANDRA
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALEXANDRA
Last Name:SEYDOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 S REGAL ST APT C3018
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7911
Mailing Address - Country:US
Mailing Address - Phone:763-360-3880
Mailing Address - Fax:
Practice Address - Street 1:5015 S REGAL ST APT C3018
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7911
Practice Address - Country:US
Practice Address - Phone:763-360-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAS161352946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty