Provider Demographics
NPI:1386781094
Name:JOHNSON, MEGAN LYNN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:PELIGATTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10625 TEACHOUT RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-4338
Mailing Address - Country:US
Mailing Address - Phone:352-598-2588
Mailing Address - Fax:
Practice Address - Street 1:10625 TEACHOUT RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-3702
Practice Address - Country:US
Practice Address - Phone:352-598-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist