Healthcare Provider Details

I. General information

NPI: 1295262525
Provider Name (Legal Business Name): MEGAN R. HANCOVSKY M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN SMITH

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 W 4TH ST
ONTARIO OH
44906-1865
US

IV. Provider business mailing address

DEPT 781629
DETROIT MI
48278-1629
US

V. Phone/Fax

Practice location:
  • Phone: 567-307-6008
  • Fax:
Mailing address:
  • Phone: 614-722-3841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12515
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: