Basic Information
| Provider Information | |||||||||
| NPI: | 1073591392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANEY | ||||||||
| FirstName: | MEREDITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 741 KENILWORTH AVENUE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045238027 | ||||||||
| FaxNumber: | 7045238031 | ||||||||
| Practice Location | |||||||||
| Address1: | 741 KENILWORTH AVENUE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045238027 | ||||||||
| FaxNumber: | 7045238031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP0005919 | GA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 10854 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 135284786A | 05 | GA | MEDICAID |