Provider Demographics
NPI:1760529911
Name:YAEGER, MEREDITH I (MA)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:I
Last Name:YAEGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2436
Mailing Address - Country:US
Mailing Address - Phone:516-902-6400
Mailing Address - Fax:516-623-4256
Practice Address - Street 1:2133 3RD AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2436
Practice Address - Country:US
Practice Address - Phone:516-902-6400
Practice Address - Fax:516-623-4256
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07987OtherSPEECH PATHOLOGIST