Provider Demographics
NPI:1538195953
Name:MEYER, CARRIE DAWN (AUD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:DAWN
Last Name:MEYER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:DAWN
Other - Last Name:HATHAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:560 S MAPLE ST
Mailing Address - Street 2:SUITE 40
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1733
Mailing Address - Country:US
Mailing Address - Phone:952-925-5626
Mailing Address - Fax:952-442-2180
Practice Address - Street 1:560 S MAPLE ST
Practice Address - Street 2:SUITE 40
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1733
Practice Address - Country:US
Practice Address - Phone:952-925-5626
Practice Address - Fax:952-442-2180
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6392231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN231H00000XOtherTAXONOMY CODE