=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649724550
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN FORAN M.S., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2016
-----------------------------------------------------
Last Update Date | 08/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 RIPLEY ST
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02459-2209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-567-7062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 484 MAIN ST EASTER SEALS MASSACHUSETTS
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01608-1893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-244-2756
-----------------------------------------------------
Fax | 508-831-9768
-----------------------------------------------------
=====================================================
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 | 14095281
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------