Provider Demographics
NPI:1891053443
Name:MEYERS, MARYANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 7373
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29861-7373
Mailing Address - Country:US
Mailing Address - Phone:803-507-2329
Mailing Address - Fax:803-279-7108
Practice Address - Street 1:2005 WHITE PINE DR
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2150
Practice Address - Country:US
Practice Address - Phone:803-507-2329
Practice Address - Fax:803-279-7108
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4060235Z00000X
GA006777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist