Provider Demographics
NPI:1144522376
Name:CANNIFF, MEGAN KATHERINE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:KATHERINE
Last Name:CANNIFF
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2729
Mailing Address - Country:US
Mailing Address - Phone:203-206-8694
Mailing Address - Fax:
Practice Address - Street 1:57 WHITE AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2729
Practice Address - Country:US
Practice Address - Phone:203-206-8694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003641235Z00000X
NY015338-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist