MEDICARE: MEREDITH H HUBBARD CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP10737	AZ

General Provider Information

NPI Number	:	1831613454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH H HUBBARD CCC-SLP

Provider Business Mailing Address
First Line	:	15802 N PARKVIEW PL
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-7466
Country	:	US
Telephone Number	:	623-876-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 N DYSART RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85307-2218
Country	:	US
Telephone Number	:	623-876-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	03/17/2018

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Directions to “ MEREDITH H HUBBARD CCC-SLP” Practice Location

Language	Start Address	Practice Location

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