Doctor Name: | MRS. MIRA BETH MERRIMAN |
NPI Number: | 1194839993 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA CCC-SLP |
License Number: | 5807 |
Business Practice Address: | 4330 Cedar Lake Rd S St Louis Park, MN - 554163700 |
Business Phone Number: | 9523813434 |
Business Fax Number: | 9523771430 |
Mailing Address: | 4330 Cedar Lake Rd S, ST LOUIS PARK |
State: | MN |
Postal Code: | 554163700 |
Phone Number: | 9523813434 |
Fax Number: | 9523771430 |
NPI Enumeration Date: | 08/18/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 5807 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
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 |