Provider Demographics
NPI:1053455378
Name:MEUNIER, KASEY R (LLP)
Entity Type:Individual
Prefix:MS
First Name:KASEY
Middle Name:R
Last Name:MEUNIER
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2913 BYRON CENTER AVE SW
Mailing Address - Street 2:APT 5
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-2445
Mailing Address - Country:US
Mailing Address - Phone:616-443-7150
Mailing Address - Fax:616-732-6392
Practice Address - Street 1:40 JEFFERSON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4304
Practice Address - Country:US
Practice Address - Phone:616-356-6285
Practice Address - Fax:616-832-6392
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013264103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7509106890OtherBLUE CROSS BLUE SHIELD