Healthcare Provider Details

I. General information

NPI: 1114840147
Provider Name (Legal Business Name): MEREDITH HARMON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 MIRA LOMA WAY
SAN JOSE CA
95111-3520
US

IV. Provider business mailing address

538 N 18TH ST
SAN JOSE CA
95112-1738
US

V. Phone/Fax

Practice location:
  • Phone: 408-363-5775
  • Fax:
Mailing address:
  • Phone: 408-396-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: