Provider Demographics
NPI:1679449920
Name:MEEKER, JEREMIAH DAVID
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:DAVID
Last Name:MEEKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4979 LANCASTER HLS DR APT 196
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4419
Mailing Address - Country:US
Mailing Address - Phone:619-916-9831
Mailing Address - Fax:
Practice Address - Street 1:4979 LANCASTER HLS DR APT 196
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4419
Practice Address - Country:US
Practice Address - Phone:619-916-9831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician