Provider Demographics
NPI:1831243328
Name:MEYER, BARBARA D (MSSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:D
Last Name:MEYER
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:D
Other - Last Name:DAAVETTILA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSSW
Mailing Address - Street 1:5037 W SUNBURST LANE
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKEN
Mailing Address - State:WI
Mailing Address - Zip Code:54229
Mailing Address - Country:US
Mailing Address - Phone:920-866-9153
Mailing Address - Fax:
Practice Address - Street 1:2339 CEDAR RIDGE
Practice Address - Street 2:INNOVATIVE COUNSELING INC
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313
Practice Address - Country:US
Practice Address - Phone:920-497-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6631231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39571700Medicaid
WI$$$$$$$$$007OtherBC/BS PROVIDER #
WI000344420Medicare PIN
WI88310001Medicare ID - Type Unspecified