Provider Demographics
NPI:1013755289
Name:SCHAFER, MEREDETH RYANN
Entity type:Individual
Prefix:
First Name:MEREDETH
Middle Name:RYANN
Last Name:SCHAFER
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 1:1825 GRAND ISLE CIR APT 420B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6396
Mailing Address - Country:US
Mailing Address - Phone:719-339-6278
Mailing Address - Fax:
Practice Address - Street 1:717 S STUBBS AVE APT 5
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-5661
Practice Address - Country:US
Practice Address - Phone:719-339-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician