Healthcare Provider Details

I. General information

NPI: 1518397918
Provider Name (Legal Business Name): MEGAN ROBERTS PHD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 CAMPUS DR.
EVANSTON IL
60068
US

IV. Provider business mailing address

1780 ELLIOTT ST
PARK RIDGE IL
60068-1102
US

V. Phone/Fax

Practice location:
  • Phone: 315-481-9605
  • Fax:
Mailing address:
  • Phone: 315-481-9605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number016489
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4056
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146011935
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: