MEDICARE: MEGAN VAN LAAR M.A., 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	002268	IA

General Provider Information

NPI Number	:	1861801656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN VAN LAAR M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	2461 10TH ST
Second Line	:	SUITE 203
City	:	CORALVILLE
State	:	IA
Zip	:	52241-1201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2461 10TH ST
Second Line	:	SUITE 203
City	:	CORALVILLE
State	:	IA
Zip	:	52241-1201
Country	:	US
Telephone Number	:	319-358-6323
Fax Number	:

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	08/06/2014

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