Provider Demographics
NPI:1841772746
Name:MEADOWS, KATHLEEN (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 AVIS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-8959
Mailing Address - Country:US
Mailing Address - Phone:734-477-0135
Mailing Address - Fax:734-477-0213
Practice Address - Street 1:781 AVIS DR STE 200
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-8959
Practice Address - Country:US
Practice Address - Phone:734-477-0135
Practice Address - Fax:734-477-0213
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801100999104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker