Healthcare Provider Details

I. General information

NPI: 1780949511
Provider Name (Legal Business Name): MEGHAN LINEBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 VIRGINIA AVE
WYTHEVILLE VA
24382-1185
US

IV. Provider business mailing address

3450 W CENTRAL AVE SUITE 230
TOLEDO OH
43606-1416
US

V. Phone/Fax

Practice location:
  • Phone: 276-228-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12054028
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: