Provider Demographics
NPI:1902035850
Name:STOCK, MEGAN (SLP)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:STOCK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12732
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-2732
Mailing Address - Country:US
Mailing Address - Phone:843-314-5434
Mailing Address - Fax:843-314-5434
Practice Address - Street 1:3030 ASHLEY TOWN CENTER DR
Practice Address - Street 2:UNIT B-203
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5664
Practice Address - Country:US
Practice Address - Phone:843-314-5434
Practice Address - Fax:843-314-5434
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1346Medicaid