Provider Demographics
NPI:1609186063
Name:MEREDITH, JESSICA E (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3554
Mailing Address - Country:US
Mailing Address - Phone:812-282-1888
Mailing Address - Fax:812-218-9318
Practice Address - Street 1:510 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3554
Practice Address - Country:US
Practice Address - Phone:812-282-1888
Practice Address - Fax:812-218-9318
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34341041C0700X
IN34006190A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100386460OtherGROUP MEDICAID NUMBER
1801014626OtherGROUP NPI NUMBER
KY6764OtherGROUP MEDICARE NUMBER
000000056294OtherANTHEM GROUP NUMBER
IN160780OtherGROUP MEDICARE NUMBER
50704000OtherGROUP MAGELLAN MIS #
1801014626OtherGROUP NPI NUMBER