Healthcare Provider Details

I. General information

NPI: 1447180336
Provider Name (Legal Business Name): AUDREY ELAINE MEADER PSY.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1458 5TH ST
MUSKEGON MI
49441-2117
US

IV. Provider business mailing address

4954 PAW PAW LAKE RD
COLOMA MI
49038-9607
US

V. Phone/Fax

Practice location:
  • Phone: 231-720-2488
  • Fax:
Mailing address:
  • Phone: 269-363-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPP0000001218376
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: