Basic Information
| Provider Information | |||||||||
| NPI: | 1376804765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORTHCUTT | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14701 BARTRAM PARK BLVD UNIT 1017 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322585295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863903847 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14286 BEACH BLVD STE 34 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322501570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043457510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA12162 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.