Provider Demographics
NPI:1487155412
Name:DE LEON, MEGHAN AUDREY
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:AUDREY
Last Name:DE LEON
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 1:13308 IRON HORSE WAY
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3966
Mailing Address - Country:US
Mailing Address - Phone:830-237-8653
Mailing Address - Fax:
Practice Address - Street 1:13308 IRON HORSE WAY
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-3966
Practice Address - Country:US
Practice Address - Phone:830-237-8653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist