Provider Demographics
NPI:1215582069
Name:MEGER, NICOLE CHANTEL
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHANTEL
Last Name:MEGER
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 1:14300 N 83RD AVE APT 1076
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5603
Mailing Address - Country:US
Mailing Address - Phone:623-313-1601
Mailing Address - Fax:
Practice Address - Street 1:8409 N 111TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-2907
Practice Address - Country:US
Practice Address - Phone:623-412-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist