Basic Information
| Provider Information | |||||||||
| NPI: | 1568436525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEINECKE | ||||||||
| FirstName: | LADONNA | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LICSW | ||||||||
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| OtherLastName: | MEINECKE | ||||||||
| OtherFirstName: | LADONNA | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8100 34TH AVE S | ||||||||
| Address2: | 21110Q | ||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554251672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528835790 | ||||||||
| FaxNumber: | 9528835395 | ||||||||
| Practice Location | |||||||||
| Address1: | 11475 ROBINSON DR NW | ||||||||
| Address2: | MAIL STOP 32600A | ||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554333746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637544600 | ||||||||
| FaxNumber: | 7637544614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 09/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2591 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.