MEDICARE: MEAGAN REYNEVELD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		TX

General Provider Information

NPI Number	:	1174134696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGAN REYNEVELD

Provider Business Mailing Address
First Line	:	405 CRAWFORD ST APT 2330
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-1395
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 CRAWFORD ST APT 2330
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-1395
Country	:	US
Telephone Number	:	661-201-2642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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Directions to “ MEAGAN REYNEVELD ” Practice Location

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