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Individual
MEGHAN WIDERBERG
Active
Individual
MEGHAN WIDERBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP 19684
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP 19684
LICENSE NUMBER
—
Enumeration date
10/18/2012
Last updated
10/22/2012
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