Provider Demographics
NPI:1184806887
Name:MEAD, DON IRA (MSW)
Entity type:Individual
Prefix:MR
First Name:DON
Middle Name:IRA
Last Name:MEAD
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 38TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419-9782
Mailing Address - Country:US
Mailing Address - Phone:269-751-6722
Mailing Address - Fax:
Practice Address - Street 1:4145 38TH ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MI
Practice Address - Zip Code:49419-9782
Practice Address - Country:US
Practice Address - Phone:269-751-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089150104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker