Provider Demographics
NPI:1609002765
Name:MEADOR, COREY DALTON (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:COREY
Middle Name:DALTON
Last Name:MEADOR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10518
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5009
Mailing Address - Country:US
Mailing Address - Phone:434-791-4691
Mailing Address - Fax:434-791-4692
Practice Address - Street 1:990 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1828
Practice Address - Country:US
Practice Address - Phone:434-791-4691
Practice Address - Fax:434-791-4692
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist