Provider Demographics
NPI:1275283699
Name:JOHNSON, MEGHAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W MAIN ST APT C
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2272
Mailing Address - Country:US
Mailing Address - Phone:224-256-7775
Mailing Address - Fax:
Practice Address - Street 1:2500 W HIGGINS RD STE 555
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7220
Practice Address - Country:US
Practice Address - Phone:630-347-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.016091235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist