Provider Demographics
NPI:1467711531
Name:PANDIAN, MEENA (MED, CRC)
Entity Type:Individual
Prefix:
First Name:MEENA
Middle Name:
Last Name:PANDIAN
Suffix:
Gender:F
Credentials:MED, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E JOHNSON ST
Mailing Address - Street 2:APT #2
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-1533
Mailing Address - Country:US
Mailing Address - Phone:262-880-9827
Mailing Address - Fax:
Practice Address - Street 1:6333 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1170
Practice Address - Country:US
Practice Address - Phone:608-270-0467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health