Provider Demographics
NPI:1922425719
Name:MANEIRA, MEREDITH KENNY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:KENNY
Last Name:MANEIRA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 WATERS COVE WAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7521
Mailing Address - Country:US
Mailing Address - Phone:925-413-8553
Mailing Address - Fax:
Practice Address - Street 1:3590 WATERS COVE WAY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7521
Practice Address - Country:US
Practice Address - Phone:925-413-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007551235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist