Provider Demographics
NPI:1710388053
Name:MEYER, PHYLLIS R (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:R
Last Name:MEYER
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 1:5133 TROY RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-9793
Mailing Address - Country:US
Mailing Address - Phone:740-972-5054
Mailing Address - Fax:
Practice Address - Street 1:683 COOVER RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-9562
Practice Address - Country:US
Practice Address - Phone:740-363-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-2407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist