Healthcare Provider Details

I. General information

NPI: 1144434499
Provider Name (Legal Business Name): JENNY E. MEISELMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 PARK DR
CHARLOTTE NC
28204-2400
US

IV. Provider business mailing address

322 S CANTERBURY RD
CHARLOTTE NC
28211-1838
US

V. Phone/Fax

Practice location:
  • Phone: 704-364-4494
  • Fax: 704-364-9230
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number489
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: