Provider Demographics
NPI:1013678044
Name:POGSON, MEREDITH ANNE
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANNE
Last Name:POGSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3964 WATERCOURSE DR APT 1354
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2082
Mailing Address - Country:US
Mailing Address - Phone:720-560-7188
Mailing Address - Fax:
Practice Address - Street 1:9850 LEGACY DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4190
Practice Address - Country:US
Practice Address - Phone:817-367-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist