Basic Information
Provider Information
NPI: 1225556582
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TALBERT
FirstName: MAEGAN
MiddleName: HORN
NamePrefix:  
NameSuffix:  
Credential: M.S.,CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 420 DEAN DR
Address2:  
City: GARDENDALE
State: AL
PostalCode: 350712763
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 420 DEAN DR
Address2:  
City: GARDENDALE
State: AL
PostalCode: 350712763
CountryCode: US
TelephoneNumber: 2056318709
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/06/2017
LastUpdateDate: 09/06/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X14115689ALN Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 
235Z00000X4079ALY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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