Provider Demographics
NPI:1477327294
Name:MEADOR, EMMA TERESE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:TERESE
Last Name:MEADOR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 N WASHINGTON ST APT 208
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3307
Mailing Address - Country:US
Mailing Address - Phone:720-431-8442
Mailing Address - Fax:
Practice Address - Street 1:785 N HUMBOLDT ST APT 3
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3557
Practice Address - Country:US
Practice Address - Phone:720-431-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist