Provider Demographics
NPI:1679550701
Name:PIERCE-CAMERON, MEREDITH (SLP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:PIERCE-CAMERON
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 1:100 N AVENUE D
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-3509
Mailing Address - Country:US
Mailing Address - Phone:940-569-3326
Mailing Address - Fax:940-766-4943
Practice Address - Street 1:100 N AVENUE D
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-3509
Practice Address - Country:US
Practice Address - Phone:940-569-3326
Practice Address - Fax:940-766-4943
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18091235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1044291OtherBLUE LINK #
TX8T3040OtherBCBS PROVIDER #
TX18091OtherHUMANA ID #