=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619023587
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN A HERING CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 10/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5330 CENTURY AVE
-----------------------------------------------------
City | MIDDLETON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53562-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-203-8880
-----------------------------------------------------
Fax | 608-203-8881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8530 GREENWAY BLVD UNIT 207
-----------------------------------------------------
City | MIDDLETON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53562-3588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 2645-154
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------