Healthcare Provider Details

I. General information

NPI: 1477952638
Provider Name (Legal Business Name): STEPHANIE MARIE MEEKER MSW, LISW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE FEICKERT MSW, LISW, CADC

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4837 1ST AVE SE SUITE 200
CEDAR RAPIDS IA
52402-3226
US

IV. Provider business mailing address

4837 1ST AVE SE SUITE 200
CEDAR RAPIDS IA
52402-3226
US

V. Phone/Fax

Practice location:
  • Phone: 319-721-0765
  • Fax:
Mailing address:
  • Phone: 319-721-0765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10038
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007103
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: