Healthcare Provider Details

I. General information

NPI: 1558086504
Provider Name (Legal Business Name): MEGAN DIMLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 AMHERST ST STE 23
NASHUA NH
03063-1019
US

IV. Provider business mailing address

44 CHERRY ST APT 6
SOMERVILLE MA
02144-3241
US

V. Phone/Fax

Practice location:
  • Phone: 603-484-4070
  • Fax:
Mailing address:
  • Phone: 951-526-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2409
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number100820
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: