Healthcare Provider Details

I. General information

NPI: 1356778633
Provider Name (Legal Business Name): MEGAN ELIZABETH CUELLAR CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN ELIZABETH MORRIS CCC-SLP

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 LACEY RD
DOWNERS GROVE IL
60515-5430
US

IV. Provider business mailing address

734 S CUYLER AVE
OAK PARK IL
60304-1506
US

V. Phone/Fax

Practice location:
  • Phone: 630-515-6144
  • Fax:
Mailing address:
  • Phone: 630-515-6237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3375
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: