Healthcare Provider Details

I. General information

NPI: 1740621408
Provider Name (Legal Business Name): MEGAN LEANN MARTIN M.S. CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 EAGLE VIEW CT
COLUMBIA MO
65203-1064
US

IV. Provider business mailing address

3807 EAGLE VIEW CT
COLUMBIA MO
65203-1064
US

V. Phone/Fax

Practice location:
  • Phone: 217-821-3455
  • Fax:
Mailing address:
  • Phone: 217-821-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2013005307
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: