MEDICARE: MEAGAN DOLIESLAGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	109233	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0031DG	OTHER	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	74-2745294	OTHER	TAX ID

General Provider Information

NPI Number	:	1295037497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGAN DOLIESLAGER

Provider Business Mailing Address
First Line	:	1201 S IH 35
Second Line	:	STE 105
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-6615
Country	:	US
Telephone Number	:	512-310-7665
Fax Number	:	512-310-9228

Provider Business Practice Location Address
First Line	:	1201 S IH 35 STE 105
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-6646
Country	:	US
Telephone Number	:	512-310-7665
Fax Number	:	512-310-9228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	06/22/2017

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Directions to “ MEAGAN DOLIESLAGER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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