Individual
MEGHAN ELYSE MOMPHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-6523
(541) 440-1000
Mailing address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-6523
(541) 440-1000
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
016516
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016516
SPEECH-LANGUAGE PATHOLOGIST LICENSE
OR
01
—
14230951
ASHA
—
Enumeration date
01/15/2021
Last updated
01/15/2021
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