Provider Demographics
NPI:1245568971
Name:MEINEN, ABBIE K (SLP)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:K
Last Name:MEINEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ABBIE
Other - Middle Name:K
Other - Last Name:DEMIANIUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 RAMAKER AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53013-1667
Mailing Address - Country:US
Mailing Address - Phone:920-889-8944
Mailing Address - Fax:
Practice Address - Street 1:531 GIDDINGS AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-1707
Practice Address - Country:US
Practice Address - Phone:920-467-2573
Practice Address - Fax:920-467-2199
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3321154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIPENDING APPLICATIONMedicaid