Provider Demographics
NPI:1366957672
Name:RICH, MEGAN K (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:K
Last Name:RICH
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 1:15149 FREEDOM WAY
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-1759
Mailing Address - Country:US
Mailing Address - Phone:815-685-4472
Mailing Address - Fax:
Practice Address - Street 1:3300 CATON FARM RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-1231
Practice Address - Country:US
Practice Address - Phone:815-436-7000
Practice Address - Fax:815-436-1233
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist