Provider Demographics
NPI:1871100818
Name:SMITH, MEGHAN (MS)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:MCWILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3925 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1226
Mailing Address - Country:US
Mailing Address - Phone:217-761-7579
Mailing Address - Fax:
Practice Address - Street 1:4680 11TH ST
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4428
Practice Address - Country:US
Practice Address - Phone:309-792-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242006151OtherSLP LICENSE