Healthcare Provider Details

I. General information

NPI: 1962560011
Provider Name (Legal Business Name): MEGAN WALSH MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4858 N HERMITAGE AVE 3B
CHICAGO IL
60640-4125
US

IV. Provider business mailing address

4858 N HERMITAGE AVE 3B
CHICAGO IL
60640-4125
US

V. Phone/Fax

Practice location:
  • Phone: 773-944-0750
  • Fax:
Mailing address:
  • Phone: 773-944-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242000274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: