Basic Information
Provider Information
NPI: 1679703292
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARTLETT
FirstName: MEAGAN
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2931 E BIDDLE ST
Address2: PATIENT ACCOUNTING
City: BALTIMORE
State: MD
PostalCode: 212133939
CountryCode: US
TelephoneNumber: 4439231886
FaxNumber: 4439231895
Practice Location
Address1: 707 N BROADWAY
Address2: KENNEDY KRIEGER INSTITUTE
City: BALTIMORE
State: MD
PostalCode: 212051832
CountryCode: US
TelephoneNumber: 4439239400
FaxNumber: 4439239405
Other Information
ProviderEnumerationDate: 07/16/2009
LastUpdateDate: 08/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X06024MDY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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