Provider Demographics
NPI:1255903027
Name:MERYUM, AISHA
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:MERYUM
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 1:15 ESTATES OF MONTCLAIRE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2581
Mailing Address - Country:US
Mailing Address - Phone:409-504-3203
Mailing Address - Fax:
Practice Address - Street 1:920 E AVENUE L
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-5014
Practice Address - Country:US
Practice Address - Phone:409-385-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist