Basic Information
| Provider Information | |||||||||
| NPI: | 1740947266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRENT | ||||||||
| FirstName: | MEGHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4858 WICK DR | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604533900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082591554 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6801 HIGH GROVE BLVD | ||||||||
| Address2: | |||||||||
| City: | BURR RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605277585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309202900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2021 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.