Provider Demographics
NPI:1104251057
Name:MEYER, CARISSA JENE (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:JENE
Last Name:MEYER
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SCOTT AND WHITE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-5601
Mailing Address - Country:US
Mailing Address - Phone:979-207-4380
Mailing Address - Fax:
Practice Address - Street 1:800 SCOTT AND WHITE BLVD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-5601
Practice Address - Country:US
Practice Address - Phone:979-207-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108213235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist