Provider Demographics
NPI:1891999835
Name:KLEMENCIC, MEREDITH MYERS
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:MYERS
Last Name:KLEMENCIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARKER CT
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1141
Mailing Address - Country:US
Mailing Address - Phone:440-286-1553
Mailing Address - Fax:
Practice Address - Street 1:100 PARKER CT
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1141
Practice Address - Country:US
Practice Address - Phone:440-286-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker