Provider Demographics
NPI:1225582810
Name:LYLE, MEAGAN (MS SLP, CFY)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:LYLE
Suffix:
Gender:F
Credentials:MS SLP, CFY
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 110
Mailing Address - Street 2:
Mailing Address - City:GILLHAM
Mailing Address - State:AR
Mailing Address - Zip Code:71841-0110
Mailing Address - Country:US
Mailing Address - Phone:870-386-2251
Mailing Address - Fax:
Practice Address - Street 1:130 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:WICKES
Practice Address - State:AR
Practice Address - Zip Code:71973-9312
Practice Address - Country:US
Practice Address - Phone:870-386-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist