MEDICARE: MEGAN NICHOLE CHARBONNEAU MS, CCC-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	60799129	WA

General Provider Information

NPI Number	:	1629580774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN NICHOLE CHARBONNEAU MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1819 N 135TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-7709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1819 N 135TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-7709
Country	:	US
Telephone Number	:	206-252-4004
Fax Number	:

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

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	10/30/2017

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