Individual
MEGHAN MARIE SUPPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
121 HOSPITAL DR, WATERTOWN, WI 53098-3303
(920) 261-9220
Mailing address
N67W28929 OLD OAK LN, HARTLAND, WI 53029-9605
(262) 510-3551
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4827154
WI
Other
Enumeration date
08/08/2019
Last updated
08/08/2019
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