Provider Demographics
NPI:1508976093
Name:WARD, MELETA JACOBS (LIC CLIN SOC WORKER)
Entity Type:Individual
Prefix:MRS
First Name:MELETA
Middle Name:JACOBS
Last Name:WARD
Suffix:
Gender:F
Credentials:LIC CLIN SOC WORKER
Other - Prefix:MISS
Other - First Name:MELETA
Other - Middle Name:ANNE
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:925 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015
Mailing Address - Country:US
Mailing Address - Phone:847-421-4910
Mailing Address - Fax:847-433-0244
Practice Address - Street 1:464 CENTRAL AVE
Practice Address - Street 2:SUITE #30
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-421-4910
Practice Address - Fax:847-433-0244
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical