Healthcare Provider Details

I. General information

NPI: 1326466004
Provider Name (Legal Business Name): MEGAN MARIE VANDEPOL MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8733 23 MILE RD
MARION MI
49665-8010
US

IV. Provider business mailing address

8733 23 MILE RD
MARION MI
49665-8010
US

V. Phone/Fax

Practice location:
  • Phone: 517-614-3146
  • Fax:
Mailing address:
  • Phone: 517-614-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101000727
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number7101000727
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: