Provider Demographics
NPI:1407982820
Name:MEYER, LEE G
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:G
Last Name:MEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 1ST ST S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4236
Mailing Address - Country:US
Mailing Address - Phone:320-214-7737
Mailing Address - Fax:320-235-0797
Practice Address - Street 1:1305 1ST ST S
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4236
Practice Address - Country:US
Practice Address - Phone:320-214-7737
Practice Address - Fax:320-235-0797
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2625237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2625OtherMN HEARING INSTRUMENT SPECIALIST