Provider Demographics
NPI:1831238047
Name:RITACCO, MEREDITH JEANNETTE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:JEANNETTE
Last Name:RITACCO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CHIEFTAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-8858
Mailing Address - Country:US
Mailing Address - Phone:863-414-0211
Mailing Address - Fax:863-465-2152
Practice Address - Street 1:116 CHIEFTAIN ST NW
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-8858
Practice Address - Country:US
Practice Address - Phone:863-414-0211
Practice Address - Fax:863-465-2152
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889870700Medicaid
FL812362400Medicaid
FLS9540OtherBLUE CROSS
FLS9540OtherBLUE CROSS