Provider Demographics
NPI:1427287648
Name:DICK, MEGHAN M (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:M
Last Name:DICK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:7401 TETIVA RD
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-9705
Mailing Address - Country:US
Mailing Address - Phone:715-797-0786
Mailing Address - Fax:
Practice Address - Street 1:7401 TETIVA RD
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-9705
Practice Address - Country:US
Practice Address - Phone:715-797-0786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3267-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist