Provider Demographics
NPI:1922843648
Name:PIERCE, MEGHAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:MCREYNOLDS-FORMWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1532 SW FELLOWS ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-5862
Mailing Address - Country:US
Mailing Address - Phone:253-906-4719
Mailing Address - Fax:
Practice Address - Street 1:2855 E HAYES ST STE 101
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1390
Practice Address - Country:US
Practice Address - Phone:503-901-5652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR015342261QH0700X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech