Provider Demographics
NPI:1356528053
Name:MERIDETH, ELIZABETH KEITH (MA CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KEITH
Last Name:MERIDETH
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 SPRING HILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3118
Mailing Address - Country:US
Mailing Address - Phone:573-243-7890
Mailing Address - Fax:
Practice Address - Street 1:347 SPRING HILL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3118
Practice Address - Country:US
Practice Address - Phone:573-243-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist