Provider Demographics
NPI:1699935494
Name:MORIARTY, MEAGHAN ALICE (MA)
Entity type:Individual
Prefix:MRS
First Name:MEAGHAN
Middle Name:ALICE
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6043 N OLYMPIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3825
Mailing Address - Country:US
Mailing Address - Phone:773-480-7706
Mailing Address - Fax:
Practice Address - Street 1:2315 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-3622
Practice Address - Country:US
Practice Address - Phone:847-467-5608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009199235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist