Meghan Marie Supple

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4827154 Issued in WI

Practice address

121 Hospital Dr
Watertown, WI 53098-3303

Phone

(920) 261-9220

NPI assigned

Aug 8, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565222400000",
    "number": "1952956633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N67W28929 OLD OAK LN",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530299605",
            "telephone_number": "262-510-3551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 HOSPITAL DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983303",
            "telephone_number": "920-261-9220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPPLE",
        "first_name": "MEGHAN",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-08",
        "last_updated": "2019-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "4827154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Watertown",
            "affiliation": "N",
            "address_1": "121 Hospital Dr",
            "city": "Watertown",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530983303",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Watertown",
            "affiliation": "N",
            "address_1": "121 Hospital Dr",
            "city": "Watertown",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530983303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gina Marie Sullivan, APNP
• Michael E Sullivan, M.D.
• Sheila Kerri Sullivan, D.O.
• Jeffrey Sundberg, D.D.S.
• Mary Supple, LPN
• Promporn June Suwanabol
• Zachary Thomas Sweatman, ATC
• Bethann Marie Swisher, PHARMD
• Kenneth Russell Tennessen, PHARMD
• Kimberly Ann Theisen, PTS

• Speech-Language Pathologist in Watertown, WI
• Providers in Watertown, WI by specialty
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.