Provider Demographics
NPI:1942740386
Name:MEISTER, KIMBERLY IRENE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:IRENE
Last Name:MEISTER
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 1:23657 LONDONDERRY
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3630
Mailing Address - Country:US
Mailing Address - Phone:248-924-7778
Mailing Address - Fax:
Practice Address - Street 1:23657 LONDONDERRY
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3630
Practice Address - Country:US
Practice Address - Phone:248-924-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-05
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401001306103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst