Provider Demographics
NPI:1093400962
Name:BOLDEN, MEREDITH ANTOINETTE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANTOINETTE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8018 VERMILION DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7514
Mailing Address - Country:US
Mailing Address - Phone:704-408-8309
Mailing Address - Fax:
Practice Address - Street 1:8018 VERMILION DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7514
Practice Address - Country:US
Practice Address - Phone:704-408-8309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30000558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist