MEDICARE: MEGAN ANDERSON

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	2014025040	MO

General Provider Information

NPI Number	:	1871994012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ANDERSON

Provider Business Mailing Address
First Line	:	6539A CLAYTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9926 FONDA DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-1422
Country	:	US
Telephone Number	:	314-869-4845
Fax Number	:

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

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	09/08/2014

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Directions to “ MEGAN ANDERSON ” Practice Location

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