Provider Demographics
NPI:1558034702
Name:MEZA, MARIA P (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:P
Last Name:MEZA
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 1:11 TREE IFIC DR W
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-7170
Mailing Address - Country:US
Mailing Address - Phone:503-577-7830
Mailing Address - Fax:
Practice Address - Street 1:4855 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-9176
Practice Address - Country:US
Practice Address - Phone:360-954-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA561167H235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist