Healthcare Provider Details

I. General information

NPI: 1124439690
Provider Name (Legal Business Name): MEGAN NIKOLE NAUMAN M.A., CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2014
Last Update Date: 05/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 E WASHINGTON ST
EAST PEORIA IL
61611-2561
US

IV. Provider business mailing address

4510 VICTORIA DR
PLAINFIELD IL
60586-8142
US

V. Phone/Fax

Practice location:
  • Phone: 309-282-6704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146009958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: