Healthcare Provider Details

I. General information

NPI: 1962970145
Provider Name (Legal Business Name): MELINDA K MEYERS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 S MAIN ST
CROWN POINT IN
46307-0114
US

IV. Provider business mailing address

623 W SOUTH ST
CROWN POINT IN
46307-4321
US

V. Phone/Fax

Practice location:
  • Phone: 219-323-8700
  • Fax:
Mailing address:
  • Phone: 773-965-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22005491A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: