Provider Demographics
NPI:1376998088
Name:MASSENBURG, MEREDITH BUSICK (SLP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:BUSICK
Last Name:MASSENBURG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 INGRAM FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9642
Mailing Address - Country:US
Mailing Address - Phone:828-371-7778
Mailing Address - Fax:
Practice Address - Street 1:1506 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2202
Practice Address - Country:US
Practice Address - Phone:828-371-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-01
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1605111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist