Provider Demographics
NPI:1083407548
Name:JOHNSON, MEGAN MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:VAN PELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15630 PINEHURST DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-8238
Mailing Address - Country:US
Mailing Address - Phone:913-273-2423
Mailing Address - Fax:
Practice Address - Street 1:15630 PINEHURST DR STE 1
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-8238
Practice Address - Country:US
Practice Address - Phone:913-273-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist