Healthcare Provider Details

I. General information

NPI: 1114138724
Provider Name (Legal Business Name): INGRID DAWN MEYER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 16TH AVE SW
CEDAR RAPIDS IA
52404-2328
US

IV. Provider business mailing address

3601 16TH AVE SW
CEDAR RAPIDS IA
52404-2328
US

V. Phone/Fax

Practice location:
  • Phone: 319-390-4611
  • Fax: 319-390-4381
Mailing address:
  • Phone: 319-390-4611
  • Fax: 319-390-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP5061
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberLP5061
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: