Provider Demographics
NPI:1649791286
Name:MEADOR, JEERNA SUSAN
Entity type:Individual
Prefix:
First Name:JEERNA
Middle Name:SUSAN
Last Name:MEADOR
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 1:6984 LAKEVIEW BLVD APT 21202
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-6641
Mailing Address - Country:US
Mailing Address - Phone:313-574-6534
Mailing Address - Fax:
Practice Address - Street 1:6984 LAKEVIEW BLVD APT 21202
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-6641
Practice Address - Country:US
Practice Address - Phone:313-574-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor