Provider Demographics
NPI:1821121021
Name:KANNER, MEREDITH ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:ANN
Last Name:KANNER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:MEREDTIH
Other - Middle Name:TANE
Other - Last Name:KANNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:7 BURLING LN
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1003
Mailing Address - Country:US
Mailing Address - Phone:516-249-5478
Mailing Address - Fax:
Practice Address - Street 1:7 BURLING LN
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1003
Practice Address - Country:US
Practice Address - Phone:516-249-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist