Provider Demographics
NPI:1114138724
Name:MEYER, INGRID DAWN (MA)
Entity Type:Individual
Prefix:MS
First Name:INGRID
Middle Name:DAWN
Last Name:MEYER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-2328
Mailing Address - Country:US
Mailing Address - Phone:319-390-4611
Mailing Address - Fax:319-390-4381
Practice Address - Street 1:3601 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-2328
Practice Address - Country:US
Practice Address - Phone:319-390-4611
Practice Address - Fax:319-390-4381
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5061103T00000X, 103TC2200X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent