Healthcare Provider Details

I. General information

NPI: 1912257072
Provider Name (Legal Business Name): ANGELA MEEKS MAED, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WAVELAND AVE
WINCHESTER KY
40391-1231
US

IV. Provider business mailing address

9 WAVELAND AVE
WINCHESTER KY
40391-1231
US

V. Phone/Fax

Practice location:
  • Phone: 855-584-5845
  • Fax: 800-584-1465
Mailing address:
  • Phone: 855-584-5845
  • Fax: 800-584-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12-074
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: