Provider Demographics
NPI:1003429747
Name:BATES, MEREDITH LIVINGSTON
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LIVINGSTON
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 NORTHEAST DR STE 23
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7425
Mailing Address - Country:US
Mailing Address - Phone:704-737-2402
Mailing Address - Fax:
Practice Address - Street 1:709 NORTHEAST DR STE 23
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7425
Practice Address - Country:US
Practice Address - Phone:704-737-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205066016Medicaid