Provider Demographics
NPI:1366921363
Name:GUBBELS, MEGAN ROSE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ROSE
Last Name:GUBBELS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68784-5014
Mailing Address - Country:US
Mailing Address - Phone:402-287-2061
Mailing Address - Fax:
Practice Address - Street 1:211 10TH ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:NE
Practice Address - Zip Code:68784-5014
Practice Address - Country:US
Practice Address - Phone:402-287-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist