Provider Demographics
NPI:1497910558
Name:MARTIN, MEGAN LECHELE (MCD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LECHELE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MCD, 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:PO BOX 2684
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-2684
Mailing Address - Country:US
Mailing Address - Phone:870-615-1750
Mailing Address - Fax:
Practice Address - Street 1:219 WILDWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-2684
Practice Address - Country:US
Practice Address - Phone:870-269-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist