Provider Demographics
NPI:1043066632
Name:MEREDITH, REBECCA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MEREDITH
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 1:22455 DISCIPLES RD
Mailing Address - Street 2:
Mailing Address - City:LONSDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72087-8009
Mailing Address - Country:US
Mailing Address - Phone:501-351-3902
Mailing Address - Fax:
Practice Address - Street 1:22455 DISCIPLES RD
Practice Address - Street 2:
Practice Address - City:LONSDALE
Practice Address - State:AR
Practice Address - Zip Code:72087-8009
Practice Address - Country:US
Practice Address - Phone:501-351-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP3318235Z00000X
MESP4093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist