Provider Demographics
NPI:1245549294
Name:MARCUS, MEREDITH T (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:T
Last Name:MARCUS
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 1:20243 LONDELIUS ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1132
Mailing Address - Country:US
Mailing Address - Phone:562-522-0111
Mailing Address - Fax:818-882-9026
Practice Address - Street 1:2208 SHERMAN WAY
Practice Address - Street 2:SUITE #206
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303
Practice Address - Country:US
Practice Address - Phone:818-884-5103
Practice Address - Fax:818-884-5369
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA9622739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist