Basic Information
| Provider Information | |||||||||
| NPI: | 1801921085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEALLER | ||||||||
| FirstName: | JO-AN | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S. CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2139 N 12TH ST | ||||||||
| Address2: | STE 4 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815012910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705494660 | ||||||||
| FaxNumber: | 9705494658 | ||||||||
| Practice Location | |||||||||
| Address1: | 2643 PATTERSON RD | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815061937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702452400 | ||||||||
| FaxNumber: | 9702429092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 103 | CO | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 840637098028 | 01 | CO | RMHP | OTHER |