Provider Demographics
NPI:1154433498
Name:MATSON, MEGHAN LAURA (MS, SLP/CCC)
Entity type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:LAURA
Last Name:MATSON
Suffix:
Gender:F
Credentials:MS, SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18718 ROGERS LK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4611
Mailing Address - Country:US
Mailing Address - Phone:210-646-8008
Mailing Address - Fax:
Practice Address - Street 1:5121 CRESTWAY DR
Practice Address - Street 2:SUITE 507
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-1980
Practice Address - Country:US
Practice Address - Phone:210-646-8008
Practice Address - Fax:210-646-8242
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75285003678239A009OtherTRICARE
TX8T1583OtherBCBS