Provider Demographics
NPI:1114261773
Name:RASCO, MEREDITH (MS)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:RASCO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 KANE CONCOURSE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2000
Mailing Address - Country:US
Mailing Address - Phone:305-866-1966
Mailing Address - Fax:
Practice Address - Street 1:1166 KANE CONCOURSE
Practice Address - Street 2:SUITE 202
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2000
Practice Address - Country:US
Practice Address - Phone:305-866-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist