Provider Demographics
NPI:1164559944
Name:AI, MENG (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MENG
Middle Name:
Last Name:AI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W KIRKWOOD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-6133
Mailing Address - Country:US
Mailing Address - Phone:812-333-1988
Mailing Address - Fax:812-822-3159
Practice Address - Street 1:101 W KIRKWOOD AVE STE 210
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-6133
Practice Address - Country:US
Practice Address - Phone:812-333-1988
Practice Address - Fax:812-822-3159
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004371A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN291383000OtherMAGELLAN PIN NUMBER
IN000000214787OtherANTHEM PIN NUMBER