Provider Demographics
NPI:1336950161
Name:TITUS, MEGHAN JANE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:JANE
Last Name:TITUS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8238 W MANCHESTER AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8147
Mailing Address - Country:US
Mailing Address - Phone:802-373-5588
Mailing Address - Fax:
Practice Address - Street 1:615 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2283
Practice Address - Country:US
Practice Address - Phone:310-606-6831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist