Healthcare Provider Details

I. General information

NPI: 1811636418
Provider Name (Legal Business Name): MEREDITH MINICH M.A. CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 KINGSWAY DR # 33
INDIANAPOLIS IN
46205-1521
US

IV. Provider business mailing address

4740 KINGSWAY DR # 33
INDIANAPOLIS IN
46205-1521
US

V. Phone/Fax

Practice location:
  • Phone: 317-466-1000
  • Fax:
Mailing address:
  • Phone: 317-466-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14547100
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: