| Doctor Name: | MEGANN IMDIEKE |
| NPI Number: | 1790157972 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 465514H |
| Business Practice Address: | 2715 Lilac St Longview, WA - 986323526 |
| Business Phone Number: | 3605757307 |
| Business Fax Number: | |
| Mailing Address: | 16313 Ne 34th St, VANCOUVER |
| State: | WA |
| Postal Code: | 986828659 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/27/2015 |
| NPI Last Update Date: | 10/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 465514H |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |