Healthcare Provider Details

I. General information

NPI: 1790067502
Provider Name (Legal Business Name): MEREDITH SUGG ANGE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600A VILLAGE WALK DR
HOLLY SPRINGS NC
27540-4438
US

IV. Provider business mailing address

600A VILLAGE WALK DR
HOLLY SPRINGS NC
27540-4438
US

V. Phone/Fax

Practice location:
  • Phone: 919-285-2157
  • Fax:
Mailing address:
  • Phone: 919-285-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10802
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP19233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: