Provider Demographics
NPI:1245558303
Name:WHITE, MEREDITH MERIE
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:MERIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S CLAREMONT AVE
Mailing Address - Street 2:APT. 1F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4342
Mailing Address - Country:US
Mailing Address - Phone:936-674-7119
Mailing Address - Fax:
Practice Address - Street 1:905 S CLAREMONT AVE
Practice Address - Street 2:APT. 1F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4342
Practice Address - Country:US
Practice Address - Phone:936-674-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist