Provider Demographics
NPI:1326375429
Name:BLACK, MERIDITH ANNE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MERIDITH
Middle Name:ANNE
Last Name:BLACK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9573 GIBBES ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-8591
Mailing Address - Country:US
Mailing Address - Phone:317-313-4242
Mailing Address - Fax:
Practice Address - Street 1:12220 N MERIDIAN ST STE 120
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6991
Practice Address - Country:US
Practice Address - Phone:317-569-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004117A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist