Provider Demographics
NPI:1679330609
Name:MEYER, MCKENNA KAY (SLP)
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:KAY
Last Name:MEYER
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 1:960 W STONEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-5070
Mailing Address - Country:US
Mailing Address - Phone:801-824-3599
Mailing Address - Fax:
Practice Address - Street 1:960 W STONEHAVEN DR
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-5070
Practice Address - Country:US
Practice Address - Phone:801-824-3599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT138636694102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist