Provider Demographics
NPI:1518668870
Name:MEREDITH, SANDRA JOANN (CHW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOANN
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 COVE AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-3906
Mailing Address - Country:US
Mailing Address - Phone:541-962-8800
Mailing Address - Fax:541-963-5272
Practice Address - Street 1:2301 COVE AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3906
Practice Address - Country:US
Practice Address - Phone:541-962-8800
Practice Address - Fax:541-963-5272
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-QMHA-R-3646101YM0800X
ORTHW000108409172V00000X
ORT-23-2797101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker