Healthcare Provider Details

I. General information

NPI: 1205182045
Provider Name (Legal Business Name): MARY MEADE M.S. SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S RANCHO SANTA FE RD
ENCINITAS CA
92024-4349
US

IV. Provider business mailing address

1058 TIGER TAIL RD
VISTA CA
92084-6315
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-4300
  • Fax:
Mailing address:
  • Phone: 760-668-5408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP18821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: