Provider Demographics
NPI:1962842716
Name:MEREDITH, CAROLYN DANA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DANA
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:DANA
Other - Last Name:HOLMES, DENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:308 MCCREADY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2752
Mailing Address - Country:US
Mailing Address - Phone:260-437-8918
Mailing Address - Fax:
Practice Address - Street 1:308 MCCREADY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2752
Practice Address - Country:US
Practice Address - Phone:260-437-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist