Provider Demographics
NPI:1396948451
Name:MEISNER, JOHN R (MS CCC A)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:MEISNER
Suffix:
Gender:M
Credentials:MS CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 AUSTINE DR
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6634
Mailing Address - Country:US
Mailing Address - Phone:802-254-3922
Mailing Address - Fax:802-258-9512
Practice Address - Street 1:209 AUSTINE DR
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6634
Practice Address - Country:US
Practice Address - Phone:802-254-3922
Practice Address - Fax:802-258-9512
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA287231H00000X
VT237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1010085Medicaid
MA1212249Medicaid
MA22T066Medicare Oscar/Certification
MA1212249Medicaid