Provider Demographics
NPI:1104491299
Name:MEREDITH, HEATHER CHRISTINE (MA, BCBA, LBA)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:CHRISTINE
Other - Last Name:DILLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA, LBA
Mailing Address - Street 1:1230 LIBERTY BANK LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5756
Mailing Address - Country:US
Mailing Address - Phone:859-360-3006
Mailing Address - Fax:
Practice Address - Street 1:1230 LIBERTY BANK LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5756
Practice Address - Country:US
Practice Address - Phone:859-360-3006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106S00000X
KY1-21-50137103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician