Provider Demographics
NPI:1235422593
Name:MEYER, MALINDA LEE (CPS TECH)
Entity Type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:LEE
Last Name:MEYER
Suffix:
Gender:F
Credentials:CPS TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-2513
Mailing Address - Country:US
Mailing Address - Phone:507-931-1550
Mailing Address - Fax:507-934-1699
Practice Address - Street 1:207 S FRONT ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-2513
Practice Address - Country:US
Practice Address - Phone:507-931-1550
Practice Address - Fax:507-934-1699
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)