MEDICARE: MEIER CLINICS FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1801265384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEIER CLINICS FOUNDATION

Provider Business Mailing Address
First Line	:	2100 MANCHESTER RD
Second Line	:	SUITE 1510
City	:	WHEATON
State	:	IL
Zip	:	60187-4561
Country	:	US
Telephone Number	:	630-653-1717
Fax Number	:	630-653-9691

Provider Business Practice Location Address
First Line	:	8350 OKEECHOBEE BLVD
Second Line	:	C/O GRACE FELLOWSHIP
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-1925
Country	:	US
Telephone Number	:	630-653-1717
Fax Number	:	630-653-9691

Authorized Official
Title or Position	:	NATIONAL EXECUTIVE ASSISTANT
Name	:	SANDY NEWPORT
Credential	:
Telephone Number	:	630-653-1717

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	09/28/2015

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Directions to “MEIER CLINICS FOUNDATION ” Practice Location

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