Provider Demographics
NPI:1104955657
Name:MEADE, LONNIE STEPHAN JR (MA, CCC SLP)
Entity type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:STEPHAN
Last Name:MEADE
Suffix:JR
Gender:M
Credentials:MA, CCC SLP
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Mailing Address - Street 1:11304 E 26TH LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-8940
Mailing Address - Country:US
Mailing Address - Phone:928-344-6856
Mailing Address - Fax:928-344-6930
Practice Address - Street 1:450 W 6TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2973
Practice Address - Country:US
Practice Address - Phone:928-502-4300
Practice Address - Fax:928-502-4442
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZSLP4179235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist