Provider Demographics
NPI:1467274829
Name:MERRITT, JON
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:MERRITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 VINAL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4825
Mailing Address - Country:US
Mailing Address - Phone:207-691-1732
Mailing Address - Fax:
Practice Address - Street 1:625 ROCKLAND ST STE 2
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5387
Practice Address - Country:US
Practice Address - Phone:207-230-1113
Practice Address - Fax:207-230-1113
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDL483237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist