Provider Demographics
NPI:1215214028
Name:MEISTER, VICKIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:
Last Name:MEISTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:680 S WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3656
Mailing Address - Country:US
Mailing Address - Phone:909-917-6050
Mailing Address - Fax:
Practice Address - Street 1:3760 CONVOY ST
Practice Address - Street 2:STE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3742
Practice Address - Country:US
Practice Address - Phone:858-514-0375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16859235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist