Provider Demographics
NPI:1154562866
Name:MEESE, JEANINE G
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:G
Last Name:MEESE
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 1:2954 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8454
Mailing Address - Country:US
Mailing Address - Phone:850-389-4202
Mailing Address - Fax:
Practice Address - Street 1:5165 CANAL ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-2256
Practice Address - Country:US
Practice Address - Phone:850-623-4054
Practice Address - Fax:850-623-4987
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist