Provider Demographics
NPI:1376187559
Name:FITZGIBBONS, MEREDITH S (SLP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:S
Last Name:FITZGIBBONS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:S
Other - Last Name:SALETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3450 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5430
Mailing Address - Country:US
Mailing Address - Phone:630-743-4500
Mailing Address - Fax:630-743-4567
Practice Address - Street 1:3450 LACEY RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5430
Practice Address - Country:US
Practice Address - Phone:630-743-4500
Practice Address - Fax:630-743-4567
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist