Provider Demographics
NPI:1174831838
Name:BLAIR DESAULNIERS, MEREDITH ALISSA (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ALISSA
Last Name:BLAIR DESAULNIERS
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:ANTRIM
Mailing Address - State:NH
Mailing Address - Zip Code:03440-3607
Mailing Address - Country:US
Mailing Address - Phone:603-620-1114
Mailing Address - Fax:
Practice Address - Street 1:21 GILLIS HILL RD
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NH
Practice Address - Zip Code:03442-4402
Practice Address - Country:US
Practice Address - Phone:603-620-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist