Provider Demographics
NPI:1679833321
Name:BANDISH, MEREDITH L (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:L
Last Name:BANDISH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ASHWELL DR
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1037
Mailing Address - Country:US
Mailing Address - Phone:860-853-0205
Mailing Address - Fax:
Practice Address - Street 1:42 ASHWELL DR
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1037
Practice Address - Country:US
Practice Address - Phone:860-853-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist