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General NPI Number Information
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NPI Number | 1104390954
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Entity Type | Individual
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Provider Name | MEGHAN GREEN
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Gender | Female
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 3443 S 55TH AVE
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City | CICERO
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State | IL
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Zip | 60804-3959
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Country | US
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Telephone | 708-780-0822
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Fax |
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Provider Business Mailing Address
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Address Line | 1925 GROVE AVE APT 312
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City | BERWYN
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State | IL
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Zip | 60402-1756
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Country | US
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Telephone | 630-546-2719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 242005191
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License Number State | IL
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