Doctor Name: | JENNIFER MEEHAN |
NPI Number: | 1154721744 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ED.S. |
License Number: | 258455 |
Business Practice Address: | 1 River Bottom Rd Irmo, SC - 290638630 |
Business Phone Number: | 8034764100 |
Business Fax Number: | |
Mailing Address: | 1 River Bottom Rd, IRMO |
State: | SC |
Postal Code: | 290638630 |
Phone Number: | 8034764100 |
Fax Number: | |
NPI Enumeration Date: | 09/02/2014 |
NPI Last Update Date: | 09/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 258455 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |