Individual
MEGAN RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC, SLP
Contact information
Practice address
3320 N CLINTON ST, FORT WAYNE, IN 46805-1918
(260) 483-2100
(260) 484-5059
Mailing address
3320 N CLINTON ST, FORT WAYNE, IN 46805-1918
(260) 483-2100
(260) 484-5059
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22005870A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22005870A
STATE LICENSE
IN
Enumeration date
03/12/2014
Last updated
03/12/2014
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