Provider Demographics
NPI:1982810800
Name:CAUDILL, MEREDITH NOEL (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:NOEL
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 DAKAR DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3217
Mailing Address - Country:US
Mailing Address - Phone:321-745-2297
Mailing Address - Fax:321-269-7699
Practice Address - Street 1:5650 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7312
Practice Address - Country:US
Practice Address - Phone:331-264-9331
Practice Address - Fax:321-269-7699
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8714235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist