Provider Demographics
NPI:1265504880
Name:MEINECKE, CHRISTINE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:E
Last Name:MEINECKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 COURT AVE
Mailing Address - Street 2:#230
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2245
Mailing Address - Country:US
Mailing Address - Phone:515-699-8546
Mailing Address - Fax:515-699-5847
Practice Address - Street 1:309 COURT AVE
Practice Address - Street 2:#230
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2245
Practice Address - Country:US
Practice Address - Phone:515-699-8546
Practice Address - Fax:515-699-5847
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0543103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06517Medicare ID - Type Unspecified