Provider Demographics
NPI:1144634932
Name:PHARR, MEREDITH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:PHARR
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 1:2741 QUILLIANS DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-2885
Mailing Address - Country:US
Mailing Address - Phone:678-616-3099
Mailing Address - Fax:770-406-6840
Practice Address - Street 1:130 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:GA
Practice Address - Zip Code:30527-1804
Practice Address - Country:US
Practice Address - Phone:678-616-3099
Practice Address - Fax:770-406-6840
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP004426OtherGA SECRETARY OF STATE LICENSING BOARD
09136035OtherASHA