Provider Demographics
NPI:1891145454
Name:MEREDITH WHITE SPEECH PATHOLOGY, INC
Entity Type:Organization
Organization Name:MEREDITH WHITE SPEECH PATHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP, COM
Authorized Official - Phone:404-228-8558
Mailing Address - Street 1:1955 CLIFF VALLEY WAY NE
Mailing Address - Street 2:SUIT 245
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1955 CLIFF VALLEY WAY NE
Practice Address - Street 2:SUIT 245
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2476
Practice Address - Country:US
Practice Address - Phone:404-228-8558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008909252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency