Provider Demographics
NPI:1669073912
Name:ROBITAILLE, MEGHAN JACQUELINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:JACQUELINE
Last Name:ROBITAILLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 LIBERTY WAY
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1030
Mailing Address - Country:US
Mailing Address - Phone:860-739-4007
Mailing Address - Fax:
Practice Address - Street 1:48 DYER AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06019-3028
Practice Address - Country:US
Practice Address - Phone:860-830-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist