Provider Demographics
NPI:1306087275
Name:VAN HOUTEN, MEGAN BROOKE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:BROOKE
Last Name:VAN HOUTEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:BROOKE
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:508 MORRIS AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2517
Mailing Address - Country:US
Mailing Address - Phone:425-226-4610
Mailing Address - Fax:425-235-4758
Practice Address - Street 1:80 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5937
Practice Address - Country:US
Practice Address - Phone:425-226-4610
Practice Address - Fax:425-235-4758
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist