| Doctor Name: | ZACHARY MEDEMA |
| NPI Number: | 1124343181 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S. |
| License Number: | |
| Business Practice Address: | 634 N Main St Ste 3 O Fallon, IL - 622693733 |
| Business Phone Number: | 6186324222 |
| Business Fax Number: | |
| Mailing Address: | 408 Harvard Dr Apt C, EDWARDSVILLE |
| State: | IL |
| Postal Code: | 620252681 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/02/2010 |
| NPI Last Update Date: | 04/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |