Basic Information
Provider Information | |||||||||
NPI: | 1497087696 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MEYER | ||||||||
FirstName: | LEAH | ||||||||
MiddleName: | MARIN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.S. CF/SLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 847 WESTGATE AVE | ||||||||
Address2: | #2 | ||||||||
City: | SAINT LOUIS | ||||||||
State: | MO | ||||||||
PostalCode: | 631303411 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9132699984 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 7733 FORSYTH BOULEVARD | ||||||||
Address2: | SUITE 2300 | ||||||||
City: | ST. LOUIS | ||||||||
State: | MO | ||||||||
PostalCode: | 63105 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8006771238 | ||||||||
FaxNumber: | 3148630769 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/12/2010 | ||||||||
LastUpdateDate: | 02/12/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2009017042 | MO | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
No ID Information.