Provider Demographics
NPI:1144717851
Name:ELMORE, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ELMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 OLDE TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:SURRY
Mailing Address - State:VA
Mailing Address - Zip Code:23883-3119
Mailing Address - Country:US
Mailing Address - Phone:757-357-3204
Mailing Address - Fax:
Practice Address - Street 1:9311 HARDY CIR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-2877
Practice Address - Country:US
Practice Address - Phone:757-357-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006695235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist