MEDICARE: MEGAN CHAMBERLAIN DOUP SLP

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	22006392A	IN

General Provider Information

NPI Number	:	1205458916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN CHAMBERLAIN DOUP SLP

Provider Business Mailing Address
First Line	:	3715 RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-1102
Country	:	US
Telephone Number	:	812-390-0121
Fax Number	:

Provider Business Practice Location Address
First Line	:	3715 RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-1102
Country	:	US
Telephone Number	:	812-390-0121
Fax Number	:

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

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	05/15/2020

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