Provider Demographics
NPI:1831970805
Name:MEYER, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MEYER
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 1:16220 EDGEWATER RD NE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-4750
Mailing Address - Country:US
Mailing Address - Phone:651-261-6191
Mailing Address - Fax:
Practice Address - Street 1:16220 EDGEWATER RD NE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-4750
Practice Address - Country:US
Practice Address - Phone:651-261-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2680237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist