Healthcare Provider Details

I. General information

NPI: 1154652089
Provider Name (Legal Business Name): MARY MARTHA MEYER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N PARKVIEW PL
SURPRISE AZ
85374-7466
US

IV. Provider business mailing address

15802 N PARKVIEW PL
SURPRISE AZ
85374-7466
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number#SLPA6396
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP8523
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: