Provider Demographics
NPI:1891982161
Name:MEYER, JENNIFER (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:MACCC-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 2023
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-2023
Mailing Address - Country:US
Mailing Address - Phone:940-384-6238
Mailing Address - Fax:
Practice Address - Street 1:1105 LIVE OAK DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76227-5491
Practice Address - Country:US
Practice Address - Phone:214-538-7328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89166TOtherBCBS OK