Provider Demographics
NPI:1962754127
Name:KOPKO, MEAGHAN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:KOPKO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 GREENVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-2366
Mailing Address - Country:US
Mailing Address - Phone:845-240-3458
Mailing Address - Fax:
Practice Address - Street 1:18 TOWER LN
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1764
Practice Address - Country:US
Practice Address - Phone:203-776-0657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist