Provider Demographics
NPI:1568436525
Name:MEINECKE, LADONNA RAE (LICSW)
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:RAE
Last Name:MEINECKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LADONNA
Other - Middle Name:R
Other - Last Name:MEINECKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5790
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:11475 ROBINSON DR NW
Practice Address - Street 2:MAIL STOP 32600A
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3746
Practice Address - Country:US
Practice Address - Phone:763-754-4600
Practice Address - Fax:763-754-4614
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN429257000Medicare ID - Type Unspecified
R62765Medicare UPIN
800000846Medicare ID - Type Unspecified