Healthcare Provider Details

I. General information

NPI: 1396025045
Provider Name (Legal Business Name): KATIE LYNN MEADOR M.S., SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 N UNIVERSITY DR SUITE 5
HOLLYWOOD FL
33024-2200
US

IV. Provider business mailing address

810 SW 146TH TER
PEMBROKE PINES FL
33027-6135
US

V. Phone/Fax

Practice location:
  • Phone: 954-442-9422
  • Fax: 954-442-9150
Mailing address:
  • Phone: 408-710-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ5146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: