Provider Demographics
NPI:1083004832
Name:MEINERT, JOANNA M (MHP, CRADC, MISA I)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:MEINERT
Suffix:
Gender:F
Credentials:MHP, CRADC, MISA I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-1803
Mailing Address - Country:US
Mailing Address - Phone:618-594-4581
Mailing Address - Fax:618-594-8482
Practice Address - Street 1:580 8TH ST
Practice Address - Street 2:
Practice Address - City:CARLYLE
Practice Address - State:IL
Practice Address - Zip Code:62231-1803
Practice Address - Country:US
Practice Address - Phone:618-594-4581
Practice Address - Fax:618-594-8482
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17695101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL017695OtherDASA- DEPT OF ALCOHOL AND SUBSTANCE ABUSE