Provider Demographics
NPI:1881040145
Name:MEYER, ARICKA RENEE (LADC)
Entity Type:Individual
Prefix:MRS
First Name:ARICKA
Middle Name:RENEE
Last Name:MEYER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:ARICKA
Other - Middle Name:RENEE
Other - Last Name:FARRAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 SE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4201
Mailing Address - Country:US
Mailing Address - Phone:218-327-1105
Mailing Address - Fax:218-327-1932
Practice Address - Street 1:1215 SE 7TH AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4201
Practice Address - Country:US
Practice Address - Phone:218-327-1105
Practice Address - Fax:218-327-1932
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303749101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)